正念认知疗法和艾司西酞普兰在老年期焦虑障碍患者中的对照研究

Comparative study of mindfulness-based cognitive therapy and escitalopram in elderly patients with anxiety disorders

目的:评估团体正念认知疗法与选择性五羟色胺再摄取抑制剂对老年期焦虑障碍患者焦虑症状的等效性。方法:选择2019年1月至2020年12月期间长宁区精神卫生中心门诊就诊的老年期焦虑障碍患者80例,将入组患者采用分层区组方法随机分为正念认知组(40例)和药物治疗组(40例)。正念认知组,给与连续8周的团体MBCT。药物治疗组给与草酸艾司西酞普兰片治疗。分别于基线、4周末、8周末、12周末,对两组患者评估HAMA、TESS(仅药物治疗组)。结果:①在研究期间,共有7例患者脱落,脱落率为8.7%。正念认知组脱落4例,药物治疗组脱落3例。两组患者脱落率比较,差异无统计学意义(P>0.05)。②治疗第12周末,两组HAMA总分均有显著下降,两组内HAMA总分在不同评估时点之间的差异具有统计学意义(F=275.139,P=0.000);不同时点与分组之间不存在交互效应(P>0.05),HAMA总分组间差异无统计学意义(P>0.05),且在每个评估时点,两组之间HAMA总分之间的差异均无统计学意义(P>0.05)。③治疗12周后,和基线比较,两组患者躯体性焦虑、精神性焦虑均有明显下降,差异均有统计学意义(P<0.05)。第4周末、8周末、12周末,两组有效率比较,差异均无统计学意义(P>0.05)。④药物治疗组患者发生不良反应为恶心4例(10.8%)、口干4例(10.8%)、头痛1例(2.7%),均为极轻。结论:团体正念认知治疗和选择性五羟色胺再摄取抑制剂在改善焦虑症状,尤其是躯体性焦虑方面疗效相当,均能显著降低老年期焦虑障碍患者的焦虑症状。

Objective:To evaluate the equivalence of group mindfulness-based cognitive therapy and selective serotonin reuptake inhibitors for anxiety symptoms in elderly patients with anxiety disorders.Methods:The subjects were elderly patients with anxiety disorders admitted to the Shanghai Changning Mental Health Center from January 2019 to December 2020.A total of 80 patients were enrolled in the study.The subjects were randomly divided into MBCT(n=40)or medication group(n=40).The MBCT group received group MBCT for 8 consecutive weeks.The medication group received escitalopram oxalate tablets.HAMA and TESS(only drug treatment group)were evaluated at baseline,4th,8th,12th weekend after in two groups respectively.Results:①During the study,a total of 7 patients(8.7%)dropped out.Four cases dropped out in MBCT group,and 3 cases in medication group.There was no significant difference in the dropout rate between the two groups(P>0.05).②At the end of the 12th weekend of treatment,the HAMA total scores in both groups decreased,and the time effect was statistically significant(F=275.139,P=0.000).There was no interaction effect between time and group(P>0.05),and there was no statistically significant difference in HAMA total score between the two groups(P>0.05).At each evaluation time point,there was no statistically significant difference between the two groups in total HAMA scores(P>0.05).③After 12 weeks of treatment,compared with the baseline,the physical anxiety and mental anxiety of the two groups were significantly decreased,and the difference was statistically significant(P<0.05).At the 4th,8th and 12th weekends,there was no significant difference in the effective rate between the two groups(P>0.05).In the medication group,there were 4 cases(10.8%)of nausea,4 cases(10.8%)of dry mouth,and 1 case(2.7%)headache,all of which were very mild.Conclusion:Group mindfulness-based cognitive therapy and SSRIs are equally effective in reducing anxiety symptoms,especially somatic anxiety.