正念认知疗法联合艾司西酞普兰治疗首发青少年抑郁症的临床效果观察

Observation on clinical effect of mindfulness-based cognitive therapy combined with escitalopram in the treatment of first-episode adolescent depression

目的探讨正念认知疗法联合艾司西酞普兰治疗首发青少年抑郁症的临床效果。方法选取60例首发青少年(11~18岁)抑郁症患者,随机分为对照组和研究组,每组30例。对照组给予艾司西酞普兰治疗,研究组在对照组基础上联合正念认知疗法治疗。对比两组患者临床疗效,心理状态[汉密尔顿抑郁量表24项(HAMD-24)评分、简易应对方式量表(SCSQ)消极应对方式、SCSQ积极应对方式评分]评分,匹茨堡睡眠质量指数量表(PSQI)评分,健康状况调查简表(SF-36)评分。结果治疗8周后,研究组治疗总有效率90.0%高于对照组的66.7%,差异有统计学意义(P<0.05)。入院时,两组HAMD-24、积极应对方式、消极应对方式评分比较差异均无统计学意义(P<0.05);治疗8周后,研究组HAMD-24评分(10.47±1.54)分、SCSQ消极应对方式评分(8.57±1.94)分低于对照组的(15.35±2.12)、(15.71±2.06)分,SCSQ积极应对方式评分(26.33±3.42)分高于对照组的(18.01±3.11)分,差异有统计学意义(P<0.05)。入院时,两组患者的睡眠质量、睡眠效率、睡眠时间、入睡时间、睡眠障碍、日间功能评分及总评分比较差异均无统计学意义(P<0.05);治疗8周后,研究组患者的睡眠质量、睡眠效率、睡眠时间、入睡时间、睡眠障碍、日间功能评分及总评分分别为(0.81±0.23)、(0.92±0.24)、(0.95±0.35)、(0.81±0.33)、(0.81±0.25)、(0.81±0.22)、(5.58±0.86)分,均低于对照组的(1.26±0.37)、(1.34±0.31)、(1.44±0.42)、(1.36±0.39)、(1.38±0.32)、(1.51±0.35)、(8.21±1.04)分,差异有统计学意义(P<0.05)。入院时,两组患者的情感职能、生理功能、社会功能、总体健康评分比较差异均无统计学意义(P<0.05);治疗8周后,研究组患者的情感职能、生理功能、社会功能、总体健康评分分别为(74.36±7.14)、(82.56±7.85)、(72.77±6.19)、(77.81±5.89)分,均高于对照组的(66.17±6.73)、(73.14±6.51)、(65.07±5.97)、(67.25±6.06)分,差异有统计学意义(P<0.05)。结论首发青少年抑郁症患者采用正念认知疗法联合艾司西酞普兰治疗的效果显著,可有效减轻抑郁症状,提高睡眠及生活质量,值得临床推广应用。

Objective To discuss the clinical effect of mindfulness-based cognitive therapy combined with escitalopram in the treatment of first-episode adolescent depression.Methods A total of 60 cases of firstepisode adolescent(11-18 years old)depression were selected and randomly divided into a control group and a research group,with 30 cases in each group.The control group was treated with escitalopram,and the research group was treated with mindfulness-based cognitive therapy on the basis of the control group.Both groups were compared in terms of clinical efficacy,mental status[24-Item Hamilton Depression Rating Scale(HAMD-24)score,Simple Coping Style Questionnaire(SCSQ)negative coping style,SCSQ positive coping style score],Pittsburgh Sleep Quality Index(PSQI)score,and 36-Item Short-form Health Survey(SF-36)score.Results After 8 weeks of treatment,the total treatment efficiency of the research group was 90.0%,which was higher than 66.7%of the control group,and the difference was statistically significant(P<0.05).At admission,there was no statistically significant difference between the two groups in terms of HAMD-24 score,positive coping style score and negative coping style score(P<0.05).After 8 weeks of treatment,the HAMD-24 score(10.47±1.54)points and SCSQ negative coping style score(8.57±1.94)points of the research group were lower than(15.35±2.12)and(15.71±2.06)points of the control group;the SCSQ positive coping style score(26.33±3.42)points of the research group was higher than(18.01±3.11)points of the control group;the differences were statistically significant(P<0.05).At admission,the differences in sleep quality,sleep efficiency,sleep duration,time to fall asleep,sleep disturbance,daytime function scores and total scores between the two groups were not statistically significant(P<0.05).After 8 weeks of treatment,the sleep quality,sleep efficiency,sleep time,time to fall asleep,sleep disturbance,daytime function scores and total scores of patients in the research group were(0.81±0.23),(0.92±0.24),(0.95±0.35),(0.81±0.33),(0.81±0.25),(0.81±0.22),and(5.58±0.86)points,which were lower than(1.26±0.37),(1.34±0.31),(1.44±0.42),(1.36±0.39),(1.38±0.32),(1.51±0.35),and(8.21±1.04)points in the control group,and the differences were statistically significant(P<0.05).At admission,there was no statistically significant difference in the emotional function,physical function,social function,and overall health scores between the two groups(P<0.05).After 8 weeks of treatment,the emotional function,physical function,social function,and overall health scores of patients in the research group were(74.36±7.14),(82.56±7.85),(72.77±6.19),and(77.81±5.89)points,which were higher than(66.17±6.73),(73.14±6.51),(65.07±5.97),and(67.25±6.06)points in the control group,and the differences were statistically significant(P<0.05).Conclusion In the treatment of first-episode adolescent depression,the effect of mindfulness-based cognitive therapy combined with escitalopram is significant,which can effectively reduce depressive symptoms,improve sleep and life quality,and is worthy of clinical promotion and application.