氟西汀联合认知行为疗法治疗破坏性心境失调障碍临床研究

Clinical Study on Fluoxetine Combined with Cognitive-Behavioral Therapy in the Treatment of Destructive Mood Dysregulation Disorder

目的观察氟西汀联合认知行为疗法(CBT)治疗破坏性心境失调障碍(DMDD)的临床疗效。方法选取医院2015年1月至2018年9月收治的DMDD患儿60例,剔除脱落病例后随机分为对照组(CBT治疗,29例)和研究组(CBT联合盐酸氟西汀分散片治疗,27例),均治疗12周。结果治疗后,对照组临床疗效总评价量表(CGI)中的病情严重程度分量表(SI)和Kovacs儿童抑郁量表(CDI)评分较治疗前明显降低(P <0. 05),研究组SI、Spence儿童焦虑量表(SCAS)和CDI评分均较治疗前明显降低(P <0. 05),且研究组上述量表评分均明显低于对照组(P <0. 05);研究组患儿治疗后副反应量表(TESS)平均值为(1. 83±1. 05)分,不良反应多在服药后前2周明显,且程度轻微,改为饭后、夜间服药及暂缓加量后逐渐缓解、消失,实验室检查无异常。结论氟西汀联合CBT治疗DMDD较单用CBT更有助于改善患儿病情及焦虑、抑郁情绪,且不增加不良反应。

Objective To observe the clinical efficacy of fluoxetine combined with cognitive - behavioral therapy in the treatment of disruptive mood dysregulation disorder ( DMDD ). Methods Totally 60 patients with DMDD admitted to our hospital fom January 2015 to September 2018 were selected and randomly divided into the control group ( the patients were treated with cognitive - behavioral therapy, 29 cases ) and the study group ( the patients were treated cognitive - behavioral therapy combined with fluoxetine,27 cases ). Both groups were treated for 12 weeks. Results After treatment,the severity of illness ( SI ) score and Kovacs Children's Depression Inventory ( CDI ) score in the clinical global impression ( CGI ) of the control group were significantly lower than those before treatment ( P < 0. 05 ). The SI score,Spence Children's Anxiety Scale ( SCAS ) score and CDI score of the study group were significantly lower than those before treatment,and the above scores of the study group were significantly lower than those of the control group ( P < 0. 05 ). After treatment, the average Treatment Emergent Symptoms Scale ( TESS ) score in the study group was (1. 83 ±1. 05) points,most of the adverse reactions were obvious in the first two weeks after taking the medicine,and the degree was slight. The adverse reactions were gradually alleviated and disappeared after taking medicine after meals,at night and delayed dosage,and no abnormalities were found in laboratory tests. Conclusion Compared with cognitive - behavioral therapy alone,fluoxetine combined with cognitive - behavioral therapy in the treatment of DMDD is more helpful to improve the condition,anxiety and depression of children patients without increasing adverse reactions.