摘要
目的探讨抗抑郁药合并认知治疗对社区老年抑郁症患者残留症状的临床疗效。方法选择符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)抑郁症的诊断标准,且经过充足抗抑郁药物治疗20周以上,症状部分缓解而未达到痊愈的患者106例,按随机数字表法分为临床管理组(CM组)52例和合并认知治疗组(CBT组)54例,连续治疗20周。分别比较两组患者入组前与治疗后4、10、20周的汉密顿抑郁量表(HAMD)评分、缓解率以及48周复燃率;并对治疗前后进行特质应对方式问卷(TCSQ)评定。结果治疗第4周末,CBT组HAMD总分、焦虑因子分显著下降;治疗第20周末,两组HAMD总分、焦虑因子分、睡眠因子分、抑郁因子分均明显下降,与CM组的差异均有统计学意义(P<0.05或0.01)。CBT组有效率为68.5%(37/54),CM组为42.3%(22/52);CBT组完全缓解率(24.1%)较CM组(13.5%)高;随访48周,CBT组复燃率(22.2%)较CM组(42.3%)低;TCSQ结果显示,CBT组患者表现出更多积极的应对方式。结论抗抑郁药配合认知治疗是改善社区老年抑郁症残留症状的有效措施,在一定程度上可以减少复燃率,可能与患者应对方式的改变有关。
Objective To investigate the efficacy of anti-depression drugs combined with congnitive behavioral therapy on the residual symptoms of community elderly depression patients. Methods 106 patients met the diagnostic criteria of Amer- ican Diagnostic and Statistical Mannual of Mental Disorders-4（DSM- IV ）for depression and treated with full dose anti-depression drugs over 20 weeks were selected. The 106 cases whose symptoms were partly remitted were randomized into clinical man- agement group （CM group） or combined with congnitive behavioral therapy group （CBT group） and treated for 20 weeks. HAMD, remission rate and the currence rate after 48 weeks were compared between the two groups respectively before and 4,10,20 weeks after treatment. Besides, a trait coping style questionnaire （TCSQ） was made before and after treatment. Results At the end of the 4th week,the score of HAMD, anxiety factor of CBT group declined dramatically, while the scores of HAMD, anxiety factor, sleep factor, depression factor of CBT group all descended obviously at the end of the 20th week. There were significant differences between the two groups. The remission rate of CBT group was 68.5%（37/54） ,while that of CM group was 42.3% （22/52）. Complete remission rate （24.1%） of CBT group was higher than that of CM group （13.5%） . Moreover, the currence rate （22.2%） of CBT group was relatively lower than CM group（42.3%） after 48 weeks.In additition, TCSQ showed more positive coping style. Conclusion Anti-depression drugs combined with congnitive behavioral therapy is effective on the residual symptoms of depression. It may reduce the recurrence through the change of the coping style.
出处
《浙江医学》
CAS
2013年第23期2093-2095,2098,共4页
Zhejiang Medical Journal
基金
浙江省医药卫生科学研究基金计划A类项目(2010KYA189)
关键词
老年抑郁症
残留症状
认知治疗
药物治疗
Elderly depression Residual symptoms Congnitive behavioral therapy Drug therapy
