认知行为治疗对强迫障碍患者药物治疗依从性的影响

Influence of CBT on the Medication Compliance for the Obsessive-Compulsive Disorder Patients

目的:通过随机对照研究,分析评价认知行为治疗(CBT)对强迫障碍(OCD)患者药物治疗依从性的影响。方法:对分别接受5-羟色胺再摄取抑制剂(SSRIs)治疗(简称药物治疗组)或SSRIs联合CBT组(简称联合治疗组)的80例门诊OCD患者的药物治疗依从性进行随访研究。按照治疗方案随机分为SSRIs组(40例)和SSRIs联合CBT组(40例),被试在24周之前终止药物治疗则定义为脱落;基线时Y-BOCS的评分大于24分,则定义为高分组,反之则是低分组。结果:联合治疗组的脱落率为15%(6/40),药物治疗组的脱落率为40%(16/40),差异具有统计学意义(χ2=6.270,P<0.05);基线时Y-BOCS低分组的脱落率为36.4%(16/44),Y-BOCS高分组脱落率为16.7%(6/36),差异具有统计学意义(χ2=3.853,P<0.05);24周末完成组和脱落组Y-BOCS第4周末减分率分别为(14.62%±27.96%)和(4.42%±9.56%),差异具有统计学意义(t=-2.43,P<0.05)。回归分析结果显示:药物治疗脱落的发生和治疗的方案相关,药物治疗时联合运用CBT可降低脱落率(OR=0.279,95%CI(0.092,0.848)),有助于提高OCD患者药物治疗的依从性。结论:相对于单纯药物治疗,药物联合CBT治疗能够显著提高OCD患者的服药依从性,使患者从随后的治疗中获得更多的收获,减少症状反复。

Objective： To evaluate the drug compliance between the group of 5-selective serotonin reuptake inhibitor （SSRIs） treatment and the group of SSRIs combining cognitive-behavioral therapy（CBT） for obsessive-compulsive disorder （OCD）. Methods： 80 patients met the DSM-IV criteria for OCD were randomly assigned to group of SSRIs（n=40） and com- bined therapy group（n=40）. The basic demographic data, the score of Y-BOCS and HAMA at base line and the score-reduc- ing rate of Y-BOCS at the 4th week of the study were analyzed to learn the influence the medicine-taking compliance by Bi- nary Logistic Analysis. The drop out was defined as that the patient discontinued the drug at the 24th week. At baseline, the participants with Y-BOCS score greater than 24 was defined as the high score group, whereas those with lower than or equal to 24 was low score group. Results： The dropout rate of the combined treatment group was 15%（6/40）. The rate of drop out in the SSRIs group was 40%（16/40）. And the difference was statistically significant（x2=6.270, P〈0.05）. The drop- out rate of the low and high score group were 36.4%（16/44） and 16.7%（6/36） respectively. And the difference is statistically significant（x2=3.853, P〈0.05）. The score-reducing rate of Y-BOCS at the 4th week in the completer and drop out group were respectively（14.62%±27.96%） and（4.42%±9.56%）, which showed significant difference（t=-2.43,P〈0.05）. Regression analysis showed whether the combination of CBT is an important factor affecting the adherence of the drug[OR=0.279, 95% CI（0.092, 0.848）]. Conclusion： Drug combination CBT can significantly improve the medication compliance of patients with OCD and have the patient get long-term benefits which maybe reduce recurrence.