认知行为治疗对未服药强迫障碍患者的大样本病例研究

Efficacy of Manual-based CBT for the Drug-naive Obsessive-Compulsive Disorder Patients in China

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(OCD)患者的疗效、可接受性及适用性。方法:纳入符合DSM-IV强迫障碍诊断标准的门诊患者46例,在CBT操作手册指导下进行为期12周共14次个别CBT治疗。应用耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD-17项)和汉密尔顿焦虑量表(HAMA)进行疗效评估,并采用0-10分的视觉模拟评分法来进一步评估患者对CBT的满意度和主观有益性。研究期间不服用任何精神药物。结果:39例患者完成了14次治疗(脱落率为15.22%),对完成治疗者进行治疗前后Y-BOCS,HAMA,HAMD分值的配对t检验,结果具有显著性差异(P均小于0.01)。按照意向性治疗统计方法,有效率为69.57%(32/46),完全缓解率为21.74%(10/46),OCD患者对CBT治疗的满意度为6.89±0.42,主观有益性为6.62±0.68。结论:手册指导下的单一CBT治疗对中国OCD患者具有较好的疗效,且可接受性高,治疗依从性好。

Objective： To evaluate the efficacy of manual-based cognitive behavioral therapy（CBT） for obsessive-com- pulsive disorder（OCD）. Methods： 46 patients who met the DSM-1V OCD criteria were recruited to receive CBT. The CBT intervention was based on a manual, including 14 sessions across 12 weeks. All participants were assessed with the Yale- Brown Obsessive Compulsive Scale（Y-BOCS）, Hamilton Depression Scale（HAMD） and Hamilton Anxiety Scale（HAMA） by psychiatrists not involved in the treatment. Perceived helpfulness and satisfaction with CBT were also assessed by visual an- alogue scale（0-10）. All patients did not take any psychiatric drugs during the CBT process. Results： 39 subjects completed 14 sessions CBT. The dropout rate was 15.22%. At the end of the therapy, significant improvements were found for Y- BOCS, HAMD and HAMA by paired t test（P〈0.01）. Based on the intention to treat principle, the response and complete re- mission rate were 69.57% （32/46） and 21.74%（10/46）. Satisfaction and helpfulness ratings were acceptable. Conclusion： The manual-based CBT is an effective and feasible therapy for drug naive OCD patients in China. The patients＇ compliance is good in this therapy.