元认知训练治疗伴非自杀性自伤青少年抑郁症患者的临床疗效观察

Clinical effect of metacognitive training on adolescent depression complicated by non-suicidal self-injury

目的探讨元认知训练(MCT)治疗伴非自杀性自伤(NSSI)青少年抑郁症患者的疗效。方法将70例伴NSSI青少年抑郁症患者随机分为研究组35例和对照组35例。两组患者均给予单一选择性5-羟色胺再摄取抑制剂(SSRIs)类药物治疗,研究组在此基础上联合MCT治疗,观察4周。治疗前及治疗4周后,分别对两组患者进行汉密顿抑郁量表(HAMD)24项、汉密顿焦虑量表(HAMA)、自我伤害行为筛选量表、Snyder自我监控量表个人反应问卷(SSMS)以及反刍思维量表中文版(RRS-CV)评定,比较两组患者上述量表评分。结果治疗4周后,研究组患者HAMD评分、HAMA评分、自我伤害行为筛选量表总分和部分因子分(忧郁孤独、攻击违纪以及自残自杀)、RRS-CV总分和部分因子分(症状反刍以及反省深思)均低于对照组(P<0.05或0.01),SSMS总分及高自我监控类型占比均高于对照组(P<0.01)。结论MCT可以缓解伴NSSI青少年抑郁症患者的抑郁、焦虑情绪,改善其自我伤害行为及反刍思维,提高自我监控能力。

Objective To explore the effect of metacognitive training(MCT)on adolescent depression complicated by non-suicidal self-injury(NSSI).Methods Seventy adolescent depression patients with the NSSI were randomly divided into study(n=35)and control group(n=35).Both groups were treated with single SSRIs and on this basis study group was plus the MCT for 4 weeks.Before and after treatment the patients of both groups were assessed using the 24-item Hamilton Depression Rating Scale(HAMD-24),Hamilton Anxiety Scale(HAMA),Self-harm Behavior Screening Inventory(SHBSI),Snyder'Self-monitoring Scale(SSMS),and Ruminative Responses Scale-Chinese Version(RRS-CV)and scores of above-mentioned scales compared between two groups.Results After 4 week treatment,the HAMD and HAMA score,the total score and some factors(melancholy and loneliness,aggression and violating discipline,and self-harm and suicide)scores of the SHBSI,and the total score and some factors(symptomatic rumination and reflection)scores of the RRS-CV were lower(P<0.05 or 0.01)and the total score of the SSMS and the proportion of high self-monitoring type higher(P<0.01)in study than control group.Conclusion The MCT can alleviate depressive and anxious emotions of adolescent depression patients with the NSSI,improve self-injury behavior and rumination,and raise self-monitoring ability.