摘要
目的 探讨认知行为治疗（cognitive behavioral therapy,CBT）或支持性心理治疗联合个体化药物治疗对老年抑郁症的影响.方法 采用随机数字表法将100例老年抑郁症患者分为试验组（n=50）和对照组（n=50）,分别进行20周的药物联合CBT（试验组）或药物联合支持性心理治疗（对照组）,分别于基线、6周末、12周末和20周末采用17项汉密尔顿抑郁量表（17-item Hamilton Depression Rating Scale,HAMD17）、HAMA和社会功能量表（Social Function Rating Scale,SFRS）评估患者抑郁、焦虑状态和日常生活能力、社会功能及疗效,并将2组按照年龄和受教育年限分为不同亚组进行HAMD17总分比较.结果 基线时2组HAMD17总分差异无统计学意义;自6周末起2组HAMD17总分均明显低于基线水平,且随着治疗时间的延长,试验组较对照组HAMD17总分降低显著（t=2.48、3.89、4.72,P〈0.01或P〈0.05）;20周末HAMD17除体重因子分之外,试验组与对照组其他因子分及总分减分率差异均有统计学意义（t=-4.58,-3.76,-4.66,-2.53,-7.48,均P〈0.01）,并且2组HAMA和SFRS总分及各因子分减分率差异亦有统计学意义（t=-4.26、-3.12、-4.90,均P〈0.01;t=-7.13、-3.47、-4.19,均P〈0.01）.试验组与对照组有效率[83.7%（41/49）与68.1%（32/47）]及临床治愈率[32.7%（16/49）与12.8%（6/47）]差异均有统计学意义（χ2=6.26,P=0.007;χ2=8.53,P=0.004）.与支持性心理治疗相比,CBT对70岁及以上、高中及以下文化水平的患者疗效不明显.结论 除外高龄、低文化水平的老年抑郁症患者,CBT较支持性心理治疗能显著改善患者病情及提高社会功能.
Objective To compare the effect of combining individual medicine with cognitive behavioral therapy（CBT） or supportive psychotherapy on geriatric depression. Methods One hundred geriatric depression patients were randomly divided into study group（n=50） or control group（n=50） based on random number table method and received the combination of usual medicine with CBT or supportive psychotherapy. They were assessed blindly with17-item Hamilton Depression Rating Scale（HAMD17）, HAMA and Social Function Rating Scale（SFRS） after 0, 6, 12 and 20 week of combined treatment. According to age and education years, different subgroups of the two group were divided respectively and compared on the total score of HAMD17. Results There was no statistic difference between the two groups on the total score of HAMD17. After 6 week treatment of combining usual medicine with supportive psychotherapy or CBT, the depressed level of two groups declined significantly, and comparing with control group, the total score of HAMD17 in study group decreased significantly with the time of treatment（t=2.48, 3.89,4.72;P＆lt;0.01 or P＆lt;0.05）;except for weight factor, reducing score rates in study group on other factors or the total score of HAMD17 differed significantly from those in control group at the end of 20th week of treatment（t=-4.58,-3.76,-4.66,-2.53,-7.48,all P＆lt;0.01）, and reducing score rates of study group on the total score or each factor score of HAMA and SFRS differed significantly than those in control group （t=-4.26,-3.12,-4.90, all P＆lt;0.01; t=-7.13,-3.47,-4.19, all P＆lt;0.01）. The effective ratio in study group was significantly different with that in control group （83.7%（41/49） vs. 68.1%（32/47）; χ2=6.26,P=0.007）. The clinical cured rate was significantly higher in study group than control group（32.7%（16/49） vs.12.8%（6/47）, χ2=8.53,P=0.004）.Compared with supportive psychotherapy, CBT had no significant effect on patients who were 70 or over 70 years old and t
作者
王娜
毛佩贤
李占江
Wang Na Mao Peixian Li Zhanjiang(Department of Geriatrics and Gerontology, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China)
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2017年第5期371-376,共6页
Chinese Journal of Psychiatry
基金
首都医学发展基金（2009-3138）
关键词
老年抑郁症
认知疗法
药物疗法
随机对照试验
Geriatric depression
Cognitive therapy
Drug therapy
Randomized controlled trial
