合理情绪行为疗法治疗偏头痛(英文)

Rational emotional behavior therapy in the treatment of migraine

背景:紧张、焦虑、抑郁是偏头痛的重要诱发因素,而紧张、焦虑、抑郁与患者不合理信念、不正确的应付策略密切相关。药物疗法是目前治疗偏头痛的主要方法,但其不能改变患者的不合理信念,从而减少头痛诱发因素的产生。目的:观察药物疗法和合理情绪行为疗法对偏头痛的近远期疗效,以期为偏头痛患者提供更为安全有效的干预措施,从而改善其远期生活质量。设计:以偏头痛患者为研究对象,健康人群为对照组的观察对比研究。单位:一所市级医院的心理咨询门诊(现已撤消)。对象:研究对象为289医院心理咨询门诊1999-03/2001-10的偏头痛患者,共86例,其中男34例,女52例,年龄16～48岁,平均35岁,病程2～11年。采用查表法将86例患者随机分为合理情绪行为疗法组和药物组各43例,两组患者年龄、性别、病程、病情、文化程度差异无显著性意义。另设30例健康体检者作为对照组,其中男12例,女18例,平均36岁。方法:合理情绪行为疗法组采用合理情绪行为疗法;药物组给予阿米替林50～100mg/d,尼莫地平60mg/d,口服,治疗12周,观察24周。比较两组患者偏头痛效疗评分及治疗前后事件相关电位P300,90项症状自评量表评分。主要观察指标:两组患者偏头痛疗评分及治疗前后P300,90项症状自评量表评分比较。

BACKGROUND:Nervousness, anxiety and depression are important inducing factors of migraine,while nervousness,anxiety and depression are closely correlated with the unreasonable belief and incorrect strategy.Medicine therapy is the principa l method in the treatment of migraine at present,but it cannot change the unreas onable belief of the patients and thereby to reduce the occurrence of the induci ng factors of headache. OBJECTIVE:To observe the near term and long term therapeutic effects of medici ne therapy and rational emotional behavior therapy(REBT) to provide a safer and more effective intervention for the patients with migraine and thereby to improv e their long term quality of life(QOL). DESIGN:An observatory comparative study based on patients with migraine as sub jects and healthy population as controls. SETTING:A psychological consultation clinic of a municipal hospital(has been c anceled now). PARTICIPANTS:Totally 86 cases of migraine including 34 males and 52 females ag ed between 16 and 48 years old(means of 35 years old) with a course of disease b etween 2 and 11 years were selected from the Psychological Consultation Clinic o f the 289 Hospital between March 1999 and October 2001.All 86 cases were randoml y divided into REBT group and medicine group with 43 cases each.There was no sig nificant difference of age, gender,course of the disease,situation of the diseas e,and education background between two groups.Another 30 healthy individuals inc luding 12 males and 18 females with a mean age of 36 years old were selected in control group. METHODS:REBT was applied for patients in REBT group.Patients of medicine group r eceived 50-100 mg/day of Amitriptyline and 60 mg/day of nimodipine through oral administration.Patients received 12 weeks of therapy followed by 24 weeks of ob servation. MAIN OUTCOME MEASURES:Therapeutic scale score on migraine(TSSM),before and aft er migraine correlated potential(P300) and symptoms checklist 90(SCL 90) score s were compared. RESULTS:SCL 90 total points of two groups of patients were significantly high er than that of control group(P< 0.05);after 12 weeks of therapy,TSSM,SCL 90 to tal points and points of major factors of two groups of patients were significan tly lower compared with the situations before therapy(P< 0.05),but there was no significant difference between two therapy groups;on the 12th week after therapy ,SCL 90 total points, points for major factors and TSSM,and P300 latency of REB T group were almost as the same as that after 12 weeks of therapy and the wave a mplitude of P300 significantly elevated;owever,the differences in SCL 90 total points,points of major factors,and the TSSM in medicine group were significant c ompared with that after 12 weeks of therapy(P< 0.05).There was significant diffe rence at the same period between two therapy groups(P< 0.05). CONCLUSION:REBT can reduce the attacks of migraine,decrease TSSM,and has simil ar therapeutic effects to medicine group.Simultaneously,it can ameliorate the co gnitive disorder,change the unreasonable belief of the patients, and improve the strategy to cope with the disease;hence its long term therapeutic effect is bet ter than medicine therapy.