短程认知心理疗法结合中西药治疗老年抑郁症疗效观察

Influence of Short-term Cognitive Therapy on Therapeutic Effect of Chinese and Western Medicine for Senile Depression

【目的】观察短程认知心理疗法结合中西药治疗老年抑郁症的疗效,探索针对中国老年抑郁症群体的有效短程认知治疗程式。【方法】将71例老年抑郁症患者分为治疗组(中西药物治疗结合短程认知心理治疗者)36例及对照组(单用中西药物治疗者)35例,对照组采用西药氟西汀加中药治郁3号方(乌药、枳实、槟榔、荔枝核、菟丝子、枸杞子、郁金、合欢皮、茯苓、远志)治疗,治疗组在对照组基础上给予每周1次短程认知心理治疗,并于第5周开始日记式三栏技术应用实践。2组均于入组时(治疗前)和治疗2、4、6、8周末及半年后(6个月末)随访进行汉密尔顿抑郁量表(HAMD)评分。【结果】(1)HAMD量表总分情况:从4周末开始,2组的总分均显著降低,差异均有统计学意义(P<0.01);且从4周末开始,治疗组的降低作用优于对照组,组间比较差异有统计学意义(P<0.01)。(2)HAMD量表中焦虑/躯体化、认识障碍、阻滞、睡眠障碍、绝望感等各因子评分情况:治疗后,2组的HAMD量表各因子评分均有不同程度降低,且治疗组的降低作用优于对照组,其中焦虑/躯体化因子在8周末、6个月末差异有统计学意义(P<0.05),认识障碍因子从2周末开始差异有统计学意义(P<0.05或P<0.01),阻滞因子从6个月末开始差异有统计学意义(P<0.05),绝望感因子从4周末开始差异有统计学意义(P<0.05或P<0.01)。【结论】对老年抑郁症患者,结合短程认知心理疗法的治疗组与单纯中西药物治疗的对照组比较,起效时间无差异,但症状缓解程度及半年随访的疗效均较对照组为佳。

Objective To investigate the influence of short-term cognitive therapy on therapeutic effect of Chinese and western medicine for senile depression, and to explore the effective short-term cognitive therapy for senile depression group in China. Methods Seventy-one senile depression patients were divided into treatment group （N= 36） and control group （N=35） . Both groups were given oral use of fluoxetine and Prescription 3 for Depression （mainly composed of Radix Linderae, Fructus Aurantii Immaturus, Semen Arecae, Semen Litchi, Semen Cuscutae, Fructus Lycii, Radix Curcumae, Cortex Albiziae, Poria, and Radix Polygalae）, and the treatment group received short-term cognitive therapy once a week additionally. On week 5, the treatment group was asked to fill the three-column Daily Mood Log. Hamilton depression scale （HAMD） scores of both groups were recorded at admission, at the end of treatment week 2, 4, 6, 8, and during the follow-up （at the end of month 6）. Results （1） From the end of the treatment week 4, total HAMD scores of both groups were decreased obviously, the differences being significant compared with those before treatment （P〈0.01）, and the decrease of HAMD scores in the treatment group was superior to that in the control group （P〈0.01） . （2） After treatment, HAMD factor scores of both groups were also decreased to various degrees, and the decrease was obvious in the treatment group. The results of inter-group comparison indicated that significant differences were shown in the scores of anxiety/ somatization factor at the end of week 8 and month 6 （P〈0.05）, in the scores of cognitive disorder factor from the end of week 2 （P〈0.05 or P 〈0.01）, in the scores of retardation factor from the end of month 6 （P〈0.05）, and in the scores of despair factor from the end of week 4 （P〈0.05 or P〈0.01） . Conclusion For the treatment of senile depression patients, Chinese and western medicine plus short-term cognitive therapy or Chinese and western medicine alone has no difference in starting an effect, but the combination of medicine and short-term cognitive therapy has better effect on relievin~ symptoms and durin~ the follow-up.