动力性心理治疗合并帕罗西汀对强迫症患者疗效及防御机制的影响

The effect of psychodynamic psychotherapy combination with paroxetine on treatment of obsessive-compulsive disorder and its defense mechanism

目的 评价心理动力性心理治疗对强迫症患者疗效及防御机制的影响.方法 将符合入组标准的强迫症患者随机分成研究组和对照组,研究组42例,对照组45例.研究组接受心理动力性心理治疗联合帕罗西汀治疗,对照组单用帕罗西汀治疗,分别于治疗前、治疗第4周末、第8周末和第12周末评定Y-BOCS,在治疗前后评定防御方式问卷.结果 研究组有效率为73.8％,对照组有效率为53.3％,差异具有统计学意义（x2=3.92,P＜0.05）;自治疗第8周末开始,研究组在Y-BOCS强迫思维因子分[（8.25±4.29）分]及总分[（16.42±5.78）分]均低于对照组[（11.44±5.54）分,（21.74±4.88）分],在第12周末时Y-BOCS强迫行为因子分[（5.55±3.81）分]也低于对照组[（8.24±3.27）分],差异均有统计学意义（t=2.99,4.65,3.54,P＜0.05）;研究组不成熟防御机制的评分在治疗后[（4.24±1.27）分]较治疗前[（5.74±1.28）分]降低,而成熟防御机制的评分在治疗后[（5.56±1.74）分]较治疗前[（4.01±1.45）分]升高,差异均有统计学意义（t=5.39,4.44,P＜0.05）.结论 心理动力性心理治疗对强迫症患者有较好疗效且能改善患者的心理防御机制。

Objective To evaluate the effect of psychodynamic psychotherapy on treatment of obsessive-compulsive disorder and its defense mechanism.Methods According to the standard set of obsessive-compulsive disorder,patients were randomly divided into study group（42 cases） and the control group（45 cases）.The study group received the psychodynamic psychotherapy combined with paroxetine therapy and control group received only paroxetine therapy.The Yale-Brown Obsessive Compulsive Scale （Y-BOCS） was measured before and at the 4th,8th and 12th weekend after treatment.Defense Style Questionnaire （DSQ） was measured before and after treatment.Results Among the 42 cases in study group,the total efficacy rate were 73.8%,while the 45 cases in control group,the total efficacy rate were 53.3%,showing significant difference between the 2 groups （x2=3.92,P〈 0.05）.Since the 8th weekend after treatment,the study group got lower Y-BOCS obsessive thoughts factor score （8.25±4.29） and total score（16.42±5.78） than the control group（11.44±5.54;21.74±4.88）,the scores of Y-BOCS compulsive behavior factor score in study group（5.55±3.81） was lower than the control group（8.24±3.27） by the 12th weekend.The differences were statistical significance（t=2.99,4.65,3.54,P〈0.05）.In the study group,the score of immature defense mechanism was reduced after treatment（4.24±1.27 vs 5.74±1.28）,the score of mature defense mechanism was higher after treatment（5.56±1.74vs 4.01±1.45）.The differences were statistical significance（t=5.39,4.44,P〈0.05）.Conclusion Psychological psychotherapy is effective in patients with obsessive-compulsive disorder and psychological dynamic psychotherapy can improve the patient＇s psychological defense mechanism.