单一认知行为治疗对强迫障碍患者的疗效

Efficacy of single cognitive behavioral therapy for obsessive-compulsive disorder patients without medication

目的:验证操作手册指导下的认知行为治疗(CBT)对未服药强迫障碍患者的疗效和可接受性。方法:纳入符合美国精神障碍诊断和统计手册第4版(DSM-IV)强迫障碍诊断标准的门诊患者17例,在自行编制强迫障碍CBT操作手册指导下进行12周个别治疗。应用耶鲁-布朗强迫量表(Y-BOCS)、汉密顿抑郁量表(HAM D)和汉密顿焦虑量表(HAM A)分别于基线和12周治疗结束时进行临床症状评估。研究期间不服用任何精神药物。结果:17例强迫障碍患者中有14例完成了12次治疗(脱落率为17.6%)。12周治疗结束时,Y-BOCS总分由(22.4±5.9)下降至(9.7±6.0)分,HAMD分由(9.2±4.2)下降至(4.6±3.7),HAMA分由(14.1±4.7)下降至(5.9±4.6),均P<0.01。按照意向性治疗的统计方法,CBT对强迫障碍的有效率为70.6%(12/17),缓解率为52.9%(9/17)。结论:手册指导下的单一认知行为治疗能显著改善强迫障碍患者的强迫症状、焦虑和抑郁情绪,且患者对该疗法的接受度较高,治疗依从性较好。

Objective： To evaluate the efficacy and acceptability of cognitive behavioral therapy （CBT） based treatment manual for patients with obsessive-compulsive disorder （OCD）. Methods： Seventeen patients who met the criteria for OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-1V） were recruited to receive CBT treatment without medication. All the patients were free of psychoactive medication for at least 4 weeks before the study. The CBT treatments were based on a manual, includihg 12 individualized outpatient sessions on a weekly basis, administered by 3 trained CBT therapists. All subjects were evaluated with the Yale-Brown Obsessive Compulsive Scale （Y-BOCS）, Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） by three psychiatrists independently on the treatment at the baseline and endpoint of the therapy. The patients did not receive any treatment except for CBT during the study. Results： Fourteen subjects completed 12 sessions of CBT. The dropout rate was 17.64%. At the end of the therapy, the Y-BOCS scores decreased from （22.4 ±5.9） to （9.7 ± 6.0）. The scores of HAMD and HAMA also reduced from （9. 2 ±4.2） to （4. 6 ±3.7）, and （14. 1 ±4. 7） to （5. 9 ±4. 6） respectively （Ps 〈0.01）. Based on the intention to treat principle, the response and remission rate were 70. 6% （12/17） and 52. 9% （9/17）. Conclusion： It suggests that CBT based on the therapy manual could significantly improve obsessive-compulsive, anxiety and depressive symptoms for the drug-free patients with OCD. Meanwhile CBT is easy to be accepted by the patient and the compliance is good.