问题解决疗法对首发老年抑郁症患者临床疗效、认知及社会功能的影响

Effect of problem-solving therapy on clinical efficacy, cognitive and social function in senile patients with first episode depression

目的探讨问题解决疗法(problem-solving therapy,PST)对首发老年抑郁症患者临床疗效、认知及社会功能的影响。方法选取2020年3月至2021年8月青岛市精神卫生中心老年科收治的首发老年抑郁症患者共86例,依据随机数字表法分为研究组和对照组各43例。对照组给予抗抑郁药物治疗和精神科护理,研究组在对照组基础上给予8周PST治疗。采用17项汉密尔顿抑郁量表(Hamilton depression scale-17 items,HAMD-17)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、社会功能缺陷筛选量表(social dysfunction screening scale,SDSS)分别在干预前后对两组患者的抑郁程度、认知功能和社会功能进行评估。采用SPSS 18.0进行统计分析。两组间比较采用独立样本t检验,治疗前后比较采用配对样本t检验。结果干预8周后两组患者HAMD-17评分和SDSS评分均较干预前降低,干预前后差值差异有统计学意义(t=3.067,22.543,均P<0.05),MoCA评分明显升高,干预前后差值差异有统计学意义(t=9.623,P<0.05)。干预8周后,研究组HAMD-17评分[(14.44±1.97)分,(15.58±2.66)分,t=2.260,P=0.026]、SDSS评分[(9.44±2.24)分,(13.00±1.73)分,t=8.242,P<0.001]较对照组低,而MoCA评分[(25.44±1.28)分,(23.84±1.56)分,t=5.223,P<0.001]高于对照组。结论在常规给予抗抑郁药物治疗的基础上,PST不仅能减轻首发老年抑郁症患者的抑郁程度,而且能显著改善其认知功能和社会功能。

Objective To investigate the effect of problem-solving therapy(PST)on clinical efficacy,cognitive and social function in senile patients with first episode depression.Methods From March 2020 to August 2021,a total of 86 patients with first onset elderly depression treated in the geriatric department of Qingdao Mental Health Center were selected.According to the random number table method,totally 86 patients were randomly divided into a study group and a control group,with 43 cases in each group.The control group was treated with antidepressant drugs and basic psychiatric nursing intervention.The study group received PST treatment on the basis of the control group for 8 weeks.The Hamilton depression scale-17 items(HAMD-17),Montreal cognitive assessment scale(MoCA),and social dysfunction screening scale(SDSS)were used to assess the degree of depression,cognitive function and social function in both groups.SPSS 18.0 was used for statistical analysis.Independent sample t-test was used for comparison between groups,paired sample t-test was used for comparison before and after treatment.Results After 8 weeks of intervention,HAMD-17 scores and SDSS scores in the two groups were both significantly decreased compared with before intervention,and the differences between pre intervention and post intervention had statistical significance(t=3.067,22.543,both P<0.05),while MoCA scores were significantly increased,and the difference between pre intervention and post intervention had statistical significance(t=9.623,P<0.05).Compared with the control group after 8 weeks of intervention,the HAMD-17 score((14.44±1.97),(15.58±2.66),t=2.260,P=0.026)and SDSS score((9.44±2.24),(13.00±1.73),t=8.242,P<0.001)of the study group were lower,and the score of MoCA((25.44±1.28),(23.84±1.56),t=5.223,P<0.001)was higher.Conclusion In addition to conventional antidepressant therapy,PST not only reduces the severity of depression in elderly patients with first episode depression,but also significantly improves their cognitive and social function.