理情行为疗法对卒中后抑郁患者睡眠及情绪的影响研究

Impact of Rational Emotive Behavior Therapy on Sleep and Mood in Patients with Post-stroke Depression

背景卒中后抑郁为卒中后常见的情绪障碍,严重影响患者各项功能的恢复,单纯抗抑郁药物治疗效果不佳。目的探究理情行为疗法对卒中后抑郁患者睡眠及情绪的影响。方法选取2019年6月至2020年6月就诊于郑州大学第二附属医院神经康复科的71例卒中后抑郁患者为研究对象,依据随机数字表法分为药物对照组35例、联合治疗组36例。药物对照组患者给予盐酸舍曲林片(第1周25 mg/d,第2周起50 mg/d,连续4周),联合治疗组患者在药物对照组治疗基础上给予理情行为疗法(30 min/次,3次/周,连续4周)。分别于治疗开始前及治疗4周后应用匹兹堡睡眠质量指数量表(PSQI)、失眠严重指数量表(ISI)、汉密尔顿抑郁量表(HAMD-17项)、汉密尔顿焦虑量表(HAMA)及改良Barthel指数量表(MBI)分别对两组患者的睡眠质量、失眠程度、抑郁情况、焦虑情况及日常生活能力方面进行评定。结果两组患者治疗后PSQI、HAMA评分比较,差异无统计学意义(P>0.05);联合治疗组患者治疗后ISI、HAMD-17项评分低于药物对照组,MBI评分高于药物对照组(P<0.05)。两组患者治疗后PSQI、ISI、HAMD-17项、HAMA评分低于组内治疗前,MBI评分高于组内治疗前(P<0.05)。联合治疗组患者治疗后抑郁情况、焦虑情况改善情况优于药物对照组(P<0.05)。结论理情行为疗法结合药物治疗较单独药物治疗能更好地减轻卒中后抑郁患者失眠程度,改善情绪状态,提高日常生活能力。

Background Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke.Antidepressant drug therapy alone could not achieve satisfactory treatment responses.Objective To investigate the effects of rational emotive behavior therapy(REBT)on sleep and mood in patients with post-stroke depression.Methods Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation,the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020,and according to random number table,they were divided into the control group(n=35)or combined treatment group(n=36).The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets(25 mg per day within the first week,and 50 mg per day within other three weeks).The combined treatment group received four consecutive weeks of treatment with REBT(three times per week,the treatment duration for each time lasting for 30 minutes)plus the same treatment for the control group.Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),17-item Hamilton Depression Rating Scale(HAMD-17),Hamilton Anxiety Rating Scale(HAMA),and Modified Barthel Index(MBI)were used to assess pre-and post-treatment sleep quality,insomnia severity,depression prevalence,anxiety prevalence and ability to engage in basic activities of daily living,respectively.Results The mean scores of PSQI,ISI,HAMD-17,and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment(P<0.05).The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups(P>0.05).The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group(P<0.05).The improvement in depression was much better in the combined treatment group(P<0.05).The improvement in anxiety was more obviously in the combined treatment group(P<0.05).Conclusion REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia,mood,and ability to engage in basic activities of daily living in patients with post-stroke depression.