开放式病房中认知疗法结合百优解治疗老年抑郁性神经症的随机对照研究

目的:观察在开放式病房中认知疗法结合百优解治疗老年抑郁性神经症的效果。方法:符合CCMD-2-R抑郁性神经症诊断标准的老年抑郁性神经症患者70例随机分为对照组和联合治疗组各35例。对照组单用百优解20mg/d治疗;联合治疗组并接受认知疗法。应用Beck抑郁自评量表(BDI)、汉密顿抑郁量表(HAMD)评定两组治疗前、治疗2,4,8周(治疗结束)时的疗效;应用SCL-90量表评定两组治疗前、治疗结束、随访0.5和1a时的疗效。结果:治疗2周,联合治疗组的BDI总分和HAMD总分分别为13.8±2.6,20.8±3.1,均显著低于对照组(16.8±4.2,26.8±4.2)(t=3.527,6.667,P<0.01);治疗8周后联合治疗组的BDI总分和HAMD总分均显著低于对照组(t=2.890,3.328,P<0.01);治疗4周时,两组的BDI总分和HAMD总分差异均无显著性意义(P>0.05)。治疗8周,随访0.5年时,联合治疗组和对照组的SCL-90的躯体化、焦虑和抑郁3个因子分均显著低于治疗前(t=2.608～5.071,2.133～3.854,P<0.05～0.01);随访1年时,对照组SCL-90的3个因子分与治疗前比较,差异无显著性意义(P>0.05)。结论:认知疗法结合百优解对老年抑郁性神经症有较好的近、远期疗效和预防复发的作用。

Combined cognitive therapy with fluoxetine hydrochloride on patients with senile depressive neurosis in open wards:A randomized controlled study

AIM: To observe the effect of a combined cognitive therapy with fluoxetine hydrochloride on patients with senile depressive neurosis in open wards. METHODS:A total of 70 patients met the criterion of senile depressive neurosis described in CCMD-2-R were randomly divided into combined therapy group and control group.Each group consisted of 35 patients,the subjects of combined therapy group received 20mg fluoxetine hydrochloride combined with individual cognitive therapy daily;while the subjects of control group received 20mg fluoxetine hydrochloride daily alone.The effect of the two groups is evaluated with BDI and HAMD four times:before the treatment,2,4 and 8 weeks(the end of treatment) while under treatment.The effect of the two groups is evaluated with SCL-90 before and after the treatment,6 and 12 months after the treatment. RESULTS: Two weeks after treatment in hospital,the scores of the united group on BDI and HAMD were 13.8± 2.6, 20.8± 3.1 respectively,both were significantly lower than those of the control group,which were 16.8± 4.2,26.8± 4.2 respectively (t=3.527,6.667,P< 0.01).At the end of the positive treatment(8 weeks after admission to hospital),the scores of the united group on BDI and HAMD were 6.0± 3.8 and 5.4± 2.8 respectively,both were significantly lower than those of the control group,( t=2.890,3.328, P< 0.01) .4 weeks after admission to hospital,there was no great difference between the two groups in the scores on the two scales(P >0.05).At the end of positive treatment(8 weeks),in the 0.5 year follow up,the scores of the relative factors of somatization,anxiety and depression of SCL-90 were significantly lower than those of the pre treatment in both group( t=2.608- 5.185,P< 0.05- 0.01) .In the control group, the scores of relative factors of somatization,anxiety and depression were not significantly different from those of the pre treatment. CONCLUSION:A combined cognitive therapy with fluoxetine hydrochloride on patients with senile depressive neurosis results in quite a good effect in the near and far future, with the prevention of recurrence.