CBT团队干预对青少年双相障碍情绪调节能力的改善作用

Effect of CBT Team Intervention on Improving Emotion Regulation Ability of Adolescents with Bipolar Disorder

目的研究认知行为疗法(CBT)团队干预对青少年双相障碍情绪调节能力的改善作用。方法选取2020年2月至2021年2月芜湖市第四人民医院门诊部收治的84例青少年双向障碍混合相患者为研究对象,按照治疗方案不同分为对照组和观察组,每组42例。对照组应用喹硫平(初始剂量为25 mg/次,逐渐增加剂量至300 mg/次,每日2次)联合丙戊酸钠(初始剂量为200 mg/次,逐渐增加剂量至600 mg/次,每日2次)治疗;观察组在对照组的基础上应用CBT团队干预。两组均治疗8周。比较两组患者治疗前后狂躁症状[倍克-拉范森躁狂量表(BRMS)评分]、抑郁症状[汉密尔顿抑郁量表(HAMD)评分]、神经认知功能[威斯康星卡片分类测验(WCST)评分]、事件相关电位(ERPs)以及临床疗效。结果BRMS、HAMD评分组间、时间点的主效应差异有统计学意义(P<0.01),且组间和时点间存在交互作用(P<0.01),两组治疗后的BRMS评分、HAMD评分均低于治疗前,且观察组低于对照组(P<0.05)。WCST测验完成分类数、持续错误数、随机错误数、总错误数评分的组间、时间点的主效应差异有统计学意义(P<0.01),且组间和时点间存在交互作用(P<0.01),两组治疗后的WCST测验的完成分类数评分均高于治疗前,且观察组高于对照组(P<0.05);持续错误数、随机错误数、总错误数评分均低于治疗前,且观察组均低于对照组(P<0.05)。ERPs靶刺激P2、N2、P3在CZ点潜伏期和波幅的组间、时间点的主效应差异有统计学意义(P<0.01),且组间和时点间存在交互作用(P<0.01),两组治疗后ERPs靶刺激P2、N2、P3在CZ点的潜伏期均小于治疗前,且观察组均小于对照组(P<0.05);波幅均大于治疗前,且观察组均大于对照组(P<0.05)。观察组的总有效率高于对照组[95.24%(40/42)比80.95%(34/42)](P<0.05)。结论CBT团队干预可减轻青少年双向障碍混合相患者的狂躁症状与抑郁症状,提高神经认知功能,改善ERPs,提高临床疗效。

Objective To study the effect of cognitive behavioral therapy(CBT)team intervention on the emotional regulation ability of adolescents with bipolar disorder.Methods A total of 84 adolescent patients with mixed bipolar disorder treated in the Outpatient Department of Wuhu Fourth People′s Hospital from Feb.2020 to Feb.2021 were included,and were divided into a control group and an observation group according to different treatment schemes,with 42 cases in each group.The control group was treated with quetiapine(initial dose of 25 mg/time,gradually increased to 300 mg/time,twice a day,for 8 weeks)combined with sodium valproate(initial dose of 200 mg/time,gradually increased to 600 mg/time,twice a day,for 8 weeks).The observation group applied CBT team intervention for 8 weeks on the basis of the control group′s scheme.The manic symptoms[Bech-Rafaelsen mania scale(BRMS)],depressive symptoms[Hamilton depression scale(HAMD)],neurocognitive function[Wisconsin card sorting test(WCST)score],event-related potentials(ERPs)before and after treatment,and the clinical efficacy were compared between the two groups.Results The main effect differences of BRMS and HAMD scores between groups and time points were statistically significant(P<0.01),and there were interactions between groups and time points(P<0.01).The BRMS scores and HAMD scores of the two groups after treatment were lower than those before treatment,and the observation group was lower than that of the control group(P<0.05).There were significant differences in the main effects of WCST completion classification number,continuous error number,random error number and total error number scores between groups and time points(P<0.01),and there were interactions between groups and time points(P<0.01).The WCST completion classification number scores after treatment in the two groups were higher than those before treatment,and the observation group was higher than that in the control group(P<0.05);the scores of continuous errors,random errors and total errors were lower than those before treatment,and the scores of the observation group were lower than those of the control group(P<0.05).There were significant differences in the main effects of latency and amplitude of ERPs target stimulation P2,N2 and P3 at CZ point between groups and time points(P<0.01),and there were interactions between groups and time points(P<0.01).The latency of ERPs target stimulation P2,N2 and P3 at CZ point after treatment was less than that before treatment,and the observation group was less than that in the control group(P<0.05);the wave amplitude was greater than that before treatment,and the observation group was greater than that in the control group(P<0.05).The total effective rate of the observation group was higher than that of the control group[95.24%(40/42)vs 80.95%(34/42)](P<0.05).Conclusion The CBT team intervention can reduce manic symptoms and depressive symptoms in adolescent patients with mixed bipolar disorder,improve neurocognitive function,improve ERPs,and improve the clinical efficacy.