认知心理疗法合并氟西汀治疗精神分裂症后抑郁的疗效

目的探讨单用认知治疗以及认知方法加盐酸氟西汀治疗分裂症后抑郁的疗效和安全性。方法120例分裂症后抑郁的病人按就诊顺序抽签分为3组，即氟西汀组、认知组和综合组，氟西汀组予口服氟西汀10～40mg／d，治疗24周，认知组接受认知治疗，第1～6周为27欠／周，第7～12周为1次／周，第13～24周为1次／2周，共治疗24次；综合组接受上述两种治疗。氟西汀组脱落2例，认知组脱落1例。采取单盲法用Hamilton量表、BPRS量表、TESS量表及SERS量表，在治疗前以及开始治疗后的第2，4，8，12，24周末对3组病人进行6次疗效评定及药物副作用评定。结果（1）治疗2，4，8，12，24周后，氟西汀组的治愈率为13．2％，47．4％，73．7％，92．1％，94．7％；认知组的治愈率0，10．3％，12．8％，17．9％，28．2％；综合组治愈率为32．5％，75．0％，92．5％，95．0％，97．5％；均为综合组最高（均P〈0．01）。（2）治疗2，4，8，12，24周后3组治疗副作用比较，认知组和综合征均低于氟西汀组（均P〈0．01）。结论盐酸氟西汀合并认知心理治疗疗效优于单用氟西汀或单用认知心理治疗，且比单用氟西汀较少副作用。

Cognitive therapy and fluxetine treatment of post-schizophrenia depression

Objective To determine the efficacy and safety of cognitive therapy and fluxetine in treating post-schizophrenia depression.MethodsA mon-blind control study was carried out.120 patients meeting the CCMDIII criteria for post-schizophrenia depression were involved.The subjects were given 24 weeks fluxetine(10~40mg/d,38 cases)treatment or cognitive therapy(39 cases)or both(40 cases)respectively.The efficacy was assessed with hamilton depression scale(HAMD)and brief psychiatric rating scale(BPRS);the safety was assessed with rating scale for side effects(SERS)and treatment emergent symptom scale(TESS)at baseline and at the end of the second,fourth,eighth,twelfth and twenty-fourth week of the treatment.Results117 subjects completed the study,with 2 in fluxetine group and 1 in cognitive therapy group being dropped out.The efficacy of the combination treatment group was significantly better than that of the other two groups.The cure rates for fluxetine group after 2,4,8,12,24 weeks treatment were of 13.2%,47.4%,73.7%,92.1% and 94.7% respectively,and 0,10.3%,12.5%,17.9% and 28.2% for cognitive therapy group,and 32.5%,75.0%,92.5%,95.0% and 97.5% for combination group(P<0.01).The adverse reaction of cognitive therapy and combination treatment was milder than that of fluxetine treatment after 2,4,8,12 and 24 weeks treatment(P<0.01).ConclusionIt is effective and safe to treat post-schizophrenia depression with the combination of fluxetine and cognitive therapy.