老年抑郁症非理性信念的特点

The characteristics of irrational beliefs in patients with geriatric depression

目的:探讨老年抑郁症患者非理性信念的特点及相关因素的影响。方法:纳入100例老年抑郁症患者作为病例组,随机被分为联合治疗组1(药物联合支持性心理治疗)和联合治疗组2(药物联合认知行为治疗);选取50名年龄、性别与之匹配的正常老年人作为对照组。采用非理性信念量表(IBS)和17项汉密尔顿抑郁量表(HAMD-17)分别在治疗前及治疗12周后评估两组受试。结果:治疗前,病例组低挫折耐受、概括化评论、绝对化要求分量表分及IBS总分均显著高于对照组(t=10.86,9.20,7.18,10.52;P均<0.001);12周治疗后IBS各分量表分及总分均有显著降低(t=3.26,3.51,4.83,5.97;P<0.01或P<0.001),但在低挫折耐受分及IBS总分上与对照组差异仍有统计学意义(t=2.17,2.04;P<0.05)。治疗后,联合治疗组2较联合治疗组1IBS各分量表分及总分差异具有统计学意义(t=3.83,2.95,3.26,5.79;P均<0.001)。结论:相比支持性心理治疗,认知行为联合药物治疗降低老年抑郁症患者的非理性信念水平更佳;这些非理性信念具有某种稳定性。

Objective: To explore the characteristics of irrational beliefs and its relationship with some factors in geriatric depression patients. Method:The study chose 100 patients with geriatric depression(case group) who were randomly divided into combined treatment group 1(antidepressant combined with supportive psychotherapy) and combined treatment group 2(antidepressant combined with cognitive-behavioral therapy),and 50 age-and gender-matched normal elderly people as control group.The case group and the control group were assessed with Irrational Beliefs Scale(IBS) and the 17-item Hamilton Depression Rating Scale(HAMD-17) before treatment and after 12 weeks of combination therapy. Results:Before treatment,the subscale scores of low frustration tolerance,generalized evaluation,absolute demands and the total score of IBS were all significantly higher in case group than those in control group(t=10.86,9.20,7.18,10.52;P<0.001);all scores of IBS in case group decreased significantly after 12 weeks of combination therapy(t=3.26,3.51,4.83,5.97;P<0.01 or P<0.001),but scores of low frustration tolerance subscale and the total IBS score were still higher in the case group than those in the control group(t=2.17,2.04;P<0.05).After treatment,reduction values of the scores on IBS subscales or the total scale were more significant in combined treatment group 2 than those in combined treatment group 1(t=3.83,2.95,3.26,5.79;P<0.001). Conclusion:Compared with supportive psychotherapy,cognitive-behavioral therapy combined with medication reduces the level of irrational beliefs in elderly patients with depression better. Those irrational beliefs have a certain stability.