CBT联合小剂量利培酮治疗精神分裂症患者幻听的临床效果及安全性研究

目的探讨认知行为治疗(CBT)联合小剂量利培酮在治疗精神分裂症幻听中的临床效果和安全性。方法采用随机数字表法将80例符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)精神分裂症诊断标准的伴有幻听的患者分为CBT干预组(研究组)与药物治疗组(对照组)各40例,均采用非典型抗精神病药利培酮片治疗,CBT组药物剂量约为对照组的1/3,同时予以CBT干预。分别于入组时、3个月、6个月及随访6个月采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、副反应量表(TESS)评定患者的临床疗效及副反应情况。结果治疗3个月、6个月及随访6个月两组的PNASS评分、AHRS评分均较治疗前降低,差异有统计学意义(P0.05或0.01);随访6个月时,两组间比较差异有统计学意义(P0.05)。对照组不良反应发生率高于研究组,差异有统计学意义(χ2=5.7826,P0.05)。结论 CBT联合小剂量抗精神病药物及足量抗精神病药物治疗精神分裂症幻听均有临床效果,前者疗效的持续性及不良反应发生率可能优于后者,但需要进一步研究。

Study on the clinical effect and safety of Cognitive Behavioral Therapy with small dose risperidone in auditory hallucination of schizophrenia

Objective To explore the clinical effect and safety of cognitive behavioral therapy（ CBT）with small dose risperidone in auditory hallucination of schizophrenia. Methods According to random number table,80 cases chronic schizophrenic patients with au-ditory hallucination in accord with Chinese Classification and Diagnostic Criteria of Mental Disease,third edition（CCMD-3）diagnostic criteria were randomly divided into treatment group and control group. Both groups were treated by atypical antipsychotic risperidone,and the treatment group was given by 1/3 antipsychotic combined with CBT. Clinical efficacy and adverse reactions were evaluated by Positive and Negative Symptoms Scale（ PANSS）,Auditory Hallucinations Rating Scale（ AHRS）and Treatment Emergent Symptom Scale（ TESS） before and after treatments 3 months,6 months and 6 months follows-up. Results 3 months,6 months and 6 months follows-up after treatment,the total scores of PANSS and AHRS were reduced significantly as compared with those pretreatment（P﹤0. 05 or 0. 01）. fol-low-up of 6 months,the treatment group still has obvious improvement,there was statistically significant difference between groups（ P﹤0. 05）. The adverse reaction rate in the control group was higher than that in the treatment group,and the difference was statistically sig-nificant（χ^2 =5. 7826,P﹤0. 05）. Conclusion CBT with small antipsychotic and sufficient antipsychotic treating schizophreniaˊs auditory hallucination have evident clinical efficacy,worthy of promotion and applications. Effect of CBT with small antipsychotic in persisting effects and adverse reactions may be superior to medication,but further studies are needed.