不同治疗方案对难治性抑郁症疗效的比较

Comparison of different treatment regimens for refractory depression efficacy

目的:比较不同治疗方案对难治性抑郁症疗效及影响疗效的因素分析。方法:60例难治性抑郁症患者随机分为文拉法法辛新+碳酸锂组及文拉法辛+奥氮平组,疗程12周。治疗前后进行汉密尔顿抑郁量表17项(HAMD-17)评定;治疗后进行治疗中出现的症状量表(TESS)评定。HAMD减分率<50%的患者进行艾森克人格问卷(EPQ)调查及12周药物联合心理治疗;分析影响HAMD评分的因素。结果:治疗后两组HAMD总分、总有效率及不良反应发生率差异无统计学意义;两组共有17例患者进行药物联合心理治疗,其中14例(82.4%)有效;患者EPQ的神经质(N)分、内外向(E)分与药物联合心理治疗的疗效相关(r=-0.447,r=0.883;P均<0.01)。结论:结合心理治疗可使80%以上药物治疗无效的患者改善,人格特征影对心理治疗的疗效。

To compare the different treatment regimens for refractory depression（RD）effica-cy and its influence factors. Method：Sixty RD patients were randomly divided into venlafaxine ＋ lithium car-bonate and venlafaxine ＋ olanzapine groups and treated for 12 weeks. The patients were assessed by Hamilton depression scale 17 item（HAMD-17）before and after treatment and by treatment emergent symprom scale （TESS）after treatment. The patients whose HAMD reduced rate ﹤ 50% were assessed by Eysenck personality questionnaire（EPQ）and treated with medicine combined psychotherapy for other 12 weeks. The factors affect-ing the HAMD score were analyzed. Results：After treatment,the HAMD score,total efficiency and incidence of adverse reactions between the two groups were not significantly different. There were total 17 cases in the two groups treated with medicine combined psychotherapy and 14 cases（82. 4% ）had response. The scores of neu-roticism and extroversion in EPQ were correlatied with the efficacy（r = - 0. 447,r = 0. 883;all P ﹤ 0. 01）. Conclusion：Combining with psycholotherapy can make over 80% patients with drug invalid improved. The personality factors are influence the curative effect of psycholotherapy.