团体认知行为治疗和/或艾司西酞普兰片治疗伴有惊恐发作的轻、中度抑郁障碍患者的临床研究

Clinical trial of group cognitive behavioral therapy and/or escitalopram tablets in the treatment of mild and moderate depression patients with panic attack

目的观察团体认知行为治疗(GCBT)和/或艾司西酞普兰片治疗伴有惊恐发作的轻、中度抑郁障碍患者的临床疗效及安全性,探索治疗前后脑功能的改变情况。方法将50例伴有惊恐发作的轻、中度抑郁障碍患者随机分为A组(艾司西酞普兰单药治疗组)、B组(GCBT单独治疗组)和C组(艾司西酞普兰+GCBT联合治疗组)。治疗方法如下:艾司西酞普兰10 mg·d^(-1),qd,口服,连续治疗8周;团体认知行为治疗每周1次,每次60 min,共计8次。治疗8周末,比较3组患者的汉密尔顿抑郁量表(HAMD)减分值、惊恐障碍相关症状量表(PASS)减分值和惊恐障碍严重程度量表(PDSS)减分值,以及不良事件的发生情况。同时,进行治疗前后静息态核磁扫描。结果治疗8周末,A、B、C组的HAMD总分减分值分别为(8.15±5.68),(9.25±3.14)和(12.06±3.56)分,PASS总分减分值分别为(12.62±2.99),(10.42±2.50)和(14.71±2.08)分,PDSS总分减分值分别为(13.00±3.81),(11.50±3.94)和(14.47±2.48)分。HAMD总分减分值、PASS总分减分值和PDSS总分减分值在不同时间点存在组内差异,并在时间和组间存在交互效应(重复测量数据方差分析,P<0.05)。HAMD总分减分值与前额叶与扣带回的功能连接改变相关联(Pearson相关系数=0.502,P<0.05)。结论GCBT和/或艾司西酞普兰片治疗伴有惊恐发作的轻、中度抑郁障碍患者均有效,患者抑郁症状改善可能与其脑部静息态脑功能连接改变相关联。

Objective To explore the efficacy and safety of cognitive behavior therapy(GCBT)and/or escitalopram tablets in the treatment of mild and moderate depressive patients with panic attack,and explore the change of brain functional connectivity.Methods Fifty outpatients with mild to moderate depression with panic attacks were randomly divided into three groups:group A(escitalopram mono-therapy group),group B(GCBT therapy group),group C(escitalopram+GCBT combined therapy group).Escitalopram was 10 mg·d^(-1),qd,oral,for 8 consecutive weeks;GCBT was given once a week,60 minutes per time and 8 times total.At the end of week 8,the reduce of Hamilton depression scale(HAMD),Panic-associate symptom scale(PASS)and Panic disorder severity scale(PDSS),and adverse events were compared among three groups.Resting state functional magnetic resonance imaging(fM RI)was performed at baseline and at the end of week 8.Results At the end of week 8,for groups A,B and C,the total scores reduction of HAMD were(8.15±5.68),(9.25±3.14)and(12.06±3.56),the total scores reduction of PASS were(12.62±2.99),(10.42±2.50)and(14.71±2.08),the total scores reduction of PDSS were(13.00±3.81),(11.50±3.94)and(14.47±2.48).The differences of the total score reduction of HAMD,PASS,PDSS exist time,time×group interactive effects,those were statistically significant(repeated ANOVA,P<0.05),and the total score reduction of HAMD was associated with the functional connectivity decrease between frontal gyrus and cingulum(Pearson correlation coefficient=0.502,P<0.05).Conclusion Escitalopram and/or GCBT were effective in the treatment of mild to moderate depressive disorder with panic attack,and the patients depression improvements might be associated with fM RI connective changes.