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疗效.pdfVIP

江医学2013 年第35 卷第23 期 抗抑郁药合并认知治 对社区 老年抑郁症患者残留症状的 效 王东波 徐松泉 汤庆平 朱桂东 金国林 曹江 【摘要 】 目的 探讨抗抑郁药合并认知治 对社区老年抑郁症患者残留症状的临床 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 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 组（CBT 组）54 例，连续治 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 前后进行特质应对方式问卷（TCSQ ）评定。 结 果 治 第4 周末，CBT 组HAMD 总分、焦虑因子分显著下降；治 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。 【关键词】 老年抑郁症 残留症状 认知治 疗药物治 Efficacy of anti-depression drugs combined with congnitive behavioral therapy on the residual symptoms of community elderly depres- sion patients China 【Abstract 】 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 a