摘要
背景:喉切除术是一种常见的治疗喉癌损伤性手术作,可导致巨大的压力,但如何能减轻手术带来的心理影响知道甚少。目标:比较认知行为治疗(CBT)与药物治疗对喉切除术后咽喉癌患者焦虑和抑郁症状的治疗效果。方法:回顾湖州市第三人民医院2009年3月至2013年5月心理门诊中喉切除术后患有抑郁症或焦虑症患者的病历,确定63例患者曾接受过8周一对一的CBT治疗(其中无法说话的患者以书面形式作出回应),以及56例患者曾接受过8周的盐酸丁螺环酮治疗(n=11)、舍曲林治疗(n=9)或两种药物联合治疗(n=36)。治疗的选择(CBT或药物)是根据病人的陈述偏好而定的。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别评估治疗前后的焦虑和抑郁症状。结果:治疗8周后,两组的SAS平均分和SDS平均分都明显下降,(根据焦虑自评量表和抑郁自评量表评分标准)伴有有焦虑或者抑郁症状患者的百分比也显著下降了。但是,两种治疗方法之间没有显著差异。药物治疗组32%的参患者在治疗过程出现一个或多个不良反应,但这些都没有严重到需要停药治疗。讨论:CBT是一种有效的、短期的治疗手段,可用于减少一个人被诊断患有癌症或接受癌症治疗后往往产生的焦虑和抑郁症状。众多证据表明,这些心理症状的治疗可以提高癌症患者的生活质量和减短疾病的病程,所以肿瘤学家和其他临床医生需要定期筛查癌症患者和其他危及生命的慢性病患者的抑郁和焦虑症状,如果存在的话,就需要积极对这些症状进行治疗。这项研究表明,CBT对于即使无法说话的癌症患者来说也是有效的。
Background：Laryngectomy, a common treatment for laryngeal cancer, is a disabling operation that can induce tremendous stress, but little is known about how to alleviate the psychological effects of the operaiton. Aim： Compare the effectiveness of cognitive behavioral therapy （CBT） and medication in treating anxiety and depression among throat cancer patients after laryngectomy.Methods： Review of medical records of the psychological outpatient clinic in the Third People＇s Hospital of Huzhou City between March 2009 and May 2013 identified 63 patients with post-laryngectomy depression or anxiety disorders who received 8 weeks of one-on-one treatment with CBT （in which patients responded in writing because they were unable to speak） and 56 patients who received 8 weeks of treatment with buspirone （n=11）, sertraline （n=9） or both busipirone and sertraline （n=36）. The treatment provided （CBT or medications） was based on the stated preference of the patient. The Zung Self-rating Anxiety Scale （SAS） and the Zung Self-rating Depression Scale （SDS） were administered before and after treatment.Results： After 8 weeks of treatment the mean SAS and SDS scores had decreased significantly in both groups and the prevalence of clinically significant anxiety and depression （based on SAS and SDS cutoff scores） had dropped dramatically. There were, however, no significant differences between the two treatment methods. In the medication group 32% of participants experienced one or more adverse reactions during treatment, but none of these were severe enough to require withdrawal from treatment.Conclusions： CBT is an effective, short-term treatment for reducing the anxiety and depressive symptoms that often occur after an individual is diagnosed with cancer or treated for cancer. There is robust evidence that treatment of these psychological symptoms can improve both the quality of life and course of illness in cancer patients, so oncologists and other clinicians need to regularly screen patients with cancer and other chronic life-threatening conditions for anxiety and depression and, if present, actively promote the treatment of these symptoms. This study shows that CBT can be effective for cancer patients even when they are unable to speak.
出处
《上海精神医学》
2014年第2期95-100,共6页
Shanghai Archives of Psychiatry
关键词
认知行为治疗
喉切除术
抑郁症
焦虑症
cogniitve behavior therapy
laryngectomy
depression
anxiety disorders
