Efficacy of cognitive-behavioral therapy combined with habit reversal training on anxiety disorders in children with Tourette’s syndrome

BACKGROUND Cognitive-behavioral therapy(CBT)and habit reversal training(HRT)have shown application potential in addressing tic symptoms and comorbid psychiatric conditions.Despite their theoretical potential,empirical evidence on their combined efficacy remains limited.AIM To evaluate the efficacy of CBT combined with HRT on anxiety disorders in children with Tourette’s syndrome(TS).METHODS Clinical data of children with TS admitted to our hospital from January 2022 to June 2023 were collected,and the patients were grouped into the conventional therapy(control)group and the CBT combined with HRT group.Baseline charac-teristics,anxiety scores,tic severity scores,treatment adherence,and parental satisfaction were assessed.Statistical analysis was performed using t-tests,chi-square tests,and correlation analysis.RESULTS A total of 136 patients,including 65 patients in the control group and 71 patients in the CBT combined with HRT group,were included.The CBT combined with HRT group showed remarkable improvements compared with the control group.Post-intervention assessment revealed a decrease in anxiety scores from 63.52±1.81 to 40.53±1.64(t=2.022,P=0.045),and the Yale Global Tic Severity Scale total score decreased from 22.14±5.67 to 16.28±4.91(t=2.288,P=0.024).Treatment adherence was significantly higher in the CBT combined with HRT group(85.47±7.62%)compared with the control group(82.32±6.54%;t=2.596,P=0.010).Parental satisfaction scores were also higher in the CBT combined with HRT group(8.69±1.77)compared with the control group(7.87±1.92;t=2.592,P=0.011).CONCLUSION This study demonstrates that CBT combined with HRT significantly reduces anxiety symptoms and tic severity in children with TS,with higher treatment adherence and parental satisfaction.These findings support the potential application of this comprehensive therapeutic approach for TS treatment.

Computerized cognitive remediation therapy on cognitive impairment and social function in patients with chronic schizophrenia

BACKGROUND Patients with schizophrenia may have various disease manifestations,most of which gradually tend toward incurable chronic decline,leading to mental disability.The basic symptoms of the disease can impair social function,whereas long-term hospitalization produces hospitalization syndrome,causing serious damage to social function.AIM To investigate the effects of Computerized Cognitive Remediation Therapy(CCRT)on cognitive and social functioning in patients with chronic schizophrenia.METHODS A retrospective analysis of 120 patients with chronic schizophrenia in Shanghai Pudong New Area Mental Health Center was performed.They were divided into an intervention group(60 cases treated with CCRT combined with conventional medication)and a control group(60 cases treated with conventional medication).After treatment,effects on cognitive function and social roles were observed in both groups.The Positive and Negative Syndrome Scale(PANSS)was used to assess the patients'psychiatric symptoms.The Wisconsin Card Sorting Test(WCST)was used to assess the patients'cognitive functioning,and the Social Functioning Scale for Psychiatric Inpatients(SSPI)was used to assess the social functioning of the inpatient psychiatric patients.RESULTS No significant differences were observed in the PANSS,WCST,and SSPI intergroup scores before treatment(P>0.05).After 2,4,and 6 wk of therapy,general psychopathological factors,positive symptoms,negative symptoms,and total PANSS scores of PANSS in the intervention group were lower than in the control group(P<0.05).After 2,4,and 6 wk of treatment,the number of false responses,number of persistent bugs,and total responses in the WCST were significantly lower in the intervention group than in the control group(P<0.05),and the amount of completed classification was significantly higher than in the control group(P<0.05).After 2,4,and 6 wk of therapy,the SSPI scores were significantly greater than those of the controls(P<0.05).After 6 wk of treatment,the efficacy rates of the control and intervention groups were 81.67%and 91.67%,respectively.The curative effect in the intervention group was significantly higher than that in the control group(P<0.05).CONCLUSION CCRT can significantly improve cognitive function and social abilities in patients with chronic schizophrenia.

Cognitive-behavioral therapy for the management of irritable bowel syndrome

Irritable bowel syndrome(IBS)is a common disorder,reported to be found in 5%-20%of the general population.Its management accounts for up to 25%of a gastroenterologist’s workload in the outpatient department,and the main symptoms are abdominal pain,bloating,and altered bowel habits.Despite a great amount of available pharmacological treatments aimed at a wide variety of gastrointestinal and brain targets,many patients have not shown adequate symptom relief.In recent years,there has been increasing evidence to suggest that psychological treatments,in particular cognitive-behavioral therapy(CBT),are effective for the management of IBS.This review discusses CBT for the management of IBS.CBT has proved to be effective in alleviating the physical and psychological symptoms of IBS and has thus been recommended as a treatment option for the syndrome.

Predictors of Comorbid Psychological Symptoms among Patients with Social Anxiety Disorder after Cognitive-Behavioral Therapy

Aim: The present study aimed to examine the predictors of comorbid psychological symptoms in social anxiety disorder (SAD) after cognitive-behavioral therapy (CBT). Methods: One hundred fourteen SAD patients completed manualized group CBT. We examined associations between the personality dimensions of NEO Five Factor Index (NEO-FFI) and the subscales of Symptom Checklist-90 Revised (SCL-90-R) in SAD patients after CBT using multiple regression analysis. Results: High levels of conscientiousness at baseline predicted symptom reduction on 4 SCL-90-R scales, including somatization, obsessive-compulsive, anxiety and global severity index in patients with SAD after CBT. And high levels of agreeableness predicted symptom reduction on 2 SCL-90-R scales, including Hostility and Paranoid Ideation. High levels of openness predicted psychoticism. Conclusion: The present study suggested that high levels of three NEO-FFI dimensions (openness, agreeableness, conscientiousness) might predict comorbid psychological symptoms reduction in SAD patients after CBT. For the purpose of improving comorbid psychological symptoms with SAD patients, it might be useful to pay more attention to these dimensions of NEO-FFI at baseline.

短程团体认知行为治疗联合计算机化认知行为治疗对青少年抑郁的改善作用

目的探讨短程团体认知行为治疗(Group Cognitive Behavioral Therapy,GCBT)对青少年抑郁症患者的疗效,观察短程GCBT和计算机化认知行为治疗(Computerized Cognitive Behavioral Therapy,CCBT)联合对青少年抑郁治疗疗效。方法随机选取2022年8月—2023年8月福建省福州神经精神病防治院精神科门诊及医学心理咨询中心门诊收治的90例青少年抑郁症患者为研究对象,通过随机数表法分为CCBT组(n=30,因未完成5次治疗脱落19例,最终11例)、GCBT组(n=30,因未完成5次团体治疗脱落3例,最终27例)及CCBT+GCBT组(n=30)。在服用抗抑郁药物基础上,CCBT组合并5周的CCBT,GCBT组合并5周的GCBT,CCBT+GCBT组合并5周的GCBT及CCBT。治疗频率均为1次/周。比较3组治疗前、后汉密尔顿抑郁量表(24 Items Hamilton Depression Scale,HAMD-24)评分及减分率,中学生心理健康量表(Mental Health Scale for Middle School Students,MSSMHS)总均分及各因子分。结果5周治疗后,3组HAMD-24评分[CCBT组16(9,18)分、GCBT组18(13,21)分、CCBT+GCBT组13.5(8,20.25)分]均有明显下降,差异有统计学意义(Z=-2.847、-4.545、-4.784,P均<0.05)。3组HAMD减分率比较,差异无统计学意义(P=0.069)。CCBT+GCBT组MSSMHS总均分及强迫、敌对、人际关系敏感、抑郁、焦虑、情绪不平衡及心理不平衡等因子分与治疗前比较,差异有统计学意义(P均<0.05);GCBT组MSSMHS总均分及强迫、敌对、抑郁及情绪不平衡等因子分与治疗前比较,差异有统计学意义(P均<0.05)。CCBT+GCBT组MSSMHS人际关系敏感及心理不平衡因子分较GCBT组明显改善,差异有统计学意义(P均<0.05)。结论短程CCBT及GCBT等治疗能有效改善青少年患者的抑郁症状,且CCBT与GCBT联合治疗疗效更优于单纯GCBT,且能有效降低CCBT高脱失率。

动静调神综合疗法联合网络版认知行为疗法治疗肝郁脾虚型慢性失眠的临床疗效观察

【目的】观察动静调神综合疗法联合网络版认知行为疗法(CCBT-I)治疗肝郁脾虚型慢性失眠患者的临床疗效。【方法】将60例肝郁脾虚型慢性失眠患者随机分为观察组和对照组,每组各30例。2组患者均予以CCBT-I作为基础治疗,在此基础上,观察组给予动静调神综合疗法(由针灸调神和动静调神两部分组成)治疗,对照组给予经颅微电流刺激治疗,疗程为4周。观察2组患者治疗前后匹兹堡睡眠质量指数(PSQI)评分、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗4周后,观察组的总有效率为86.67%(26/30),对照组为70.00%(21/30);组间比较(秩和检验),观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)睡眠质量方面,治疗后,2组患者的PSQI评分均较治疗前明显下降(P<0.05),且观察组对PSQI评分的下降作用明显优于对照组,差异有统计学意义(P<0.05)。(3)焦虑、抑郁方面,治疗后,2组患者的SAS和SDS评分均较治疗前明显下降(P<0.05),且观察组对SAS和SDS评分的下降作用均有优于对照组趋势,但组间比较,差异均无统计学意义(P>0.05)。【结论】动静调神综合疗法联合CCBT-I治疗肝郁脾虚型慢性失眠,能明显改善患者的睡眠质量,缓解焦虑、抑郁情绪,提高患者生活质量,临床疗效显著。

电脑中频电治疗联合运动治疗对脑卒中偏瘫患者康复效果的影响

目的:探讨电脑中频电治疗联合运动治疗对脑卒中偏瘫患者康复效果的影响。方法:选取2021年1月—2022年12月河北燕达医院康复医学科收治的脑卒中偏瘫患者68例作为研究对象,采用随机数字表法分为对照组与观察组,各34例。对照组予以运动治疗,观察组在对照组基础上予以电脑中频电治疗。比较两组神经功能、运动功能、自理能力、治疗效果。结果:治疗前,两组美国国立卫生院卒中量表(NIHSS)、Fugl-Meyer运动功能评定量表(FMA)、Barthel指数评分比较,差异无统计学意义(P>0.05);治疗后,两组NIHSS评分降低,FMA、Barthel指数评分升高,观察组优于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.046)。结论:脑卒中偏瘫患者应用电脑中频电治疗联合运动治疗的康复效果显著,可改善神经功能、提高运动功能及自理能力。

Effectiveness of mindfulness based cognitive therapy on weight loss, improvement of hypertension and attentional bias to eating cues in overweight people

Objectives:Prevalence rates of overweight and obesity are dramatically ever-increasing across the world.Therefore,this study was to evaluate the effect of mindfulness-based cognitive therapy(MBCT)on weight loss,hypertension,and attentional bias towards food cues in a group of women affected with this condition.Methods:A total of 45 participants were selected out of women referring to the Nutrition and Diet Therapy Clinic affiliated to Shahid Beheshti University of Medical Sciences,Iran,and then randomized into three groups of 15.The first experimental group was subjected to an energy-restricted diet therapy together with MBCT during 8 sessions,the second group took the diet therapy alone,and the third group received no intervention.Body mass index(BMI),hypertension,and attentional bias towards food cues were correspondingly evaluated before,at the end,and four weeks after the completion of the interventions.Results:The results of this study revealed that MBCT,along with diet therapy,had been significantly more effective in weight loss,decrease in BMI,lower systolic blood pressure(SBP),and attentional bias towards food cues compared with the diet therapy alone(P≤0.01).MBCT had no significant impact on the decline in diastolic blood pressure(DBP)in participants in the follow-up phase.Conclusion:This study demonstrated that MBCT along with the conventional diet therapy was more effective in weight loss,decrease in BMI,hypertension control,as well as attentional bias towards food cues than the diet therapy alone.

Cognitive behavioural therapy for auditory hallucinations in schizophrenia:A review

AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy(CBT) in reduction of command hallucinations.METHODS Pub Med/MEDLINE,Cochrane Library,the Cumulative Index to Nursing and Allied Health Literature,PsycI NFO,Clinical Trial.gov searches were performed using the keywords "hallucinations","behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016.No language limits were used.Studies conducted within control group,reviews,editorials,were excluded.Data on efficacy,acceptability and tolerability were extracted by three authors independently.Disagreements were resolved in a consensus meeting or by another reviewer.RESULTS A total of eight articles were eligible for inclusion.Two are randomized clinical trials(RCTs) and six are observational studies.The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations(AHs).Nevertheless,they considered different CBT models,particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations.As regards non RCT-studies,all papers included showed reduction on frequency and severity of AHs and distress related to them.However,the lack of content details within non-RCTs studies decreased their comparability.In terms of predictive variables,our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy.Indeed,negative symptoms showed a significant negative correlation on outcome.CONCLUSION Although more conclusive studies are still needed,we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations.

Cognitive Behavior Therapy of Urinary Incontinence Phobia: A Case Report

A significant association exists between lower urinary tract symptoms and anxiety. Despite the efficacy of cognitive behavior therapies in treating a variety of phobic disorders, there are few published reports about the use of such treatments for urinary problems. We report a case of the phobia of urinary incontinence treated with cognitive behavioral techniques, which involved cognitive restructuring, distraction, relaxation training, and exposure to feared situations.

Group Therapy in Adults with Obsessive-Compulsive Disorder: A Review

In the treatment of OCD, several therapeutic approaches have been developed, including individual, group and/or pharmacological therapeutic methods. However, group therapy on OCD has received little research attention in comparison with other therapeutic methods and some studies demonstrated that OCD can be treated in group settings. In the literature, mentioned group therapies to treat OCD involve behavioral therapy, cognitive therapy, ERP (exposure and response prevention), cognitive behavioral therapy, ACT (acceptance and commitment therapy), supportive groups and individual therapy with family member involvement. In relation to their effectiveness, research indicated inconsistent findings. Therefore, the aim of this study was to address and to review whether group treatments on OCD are efficacious. This review focused on cognitive-behavioral group therapy (CBGT), ERP, and ACT.

2012—2022年计算机化认知行为疗法研究热点的可视化分析

目的了解2012—2022年十年国内外对计算机化认知行为疗法(computerized cognitive behavioral therapy,CCBT)的研究现状及研究趋势,为我国临床开展CCBT提供参考。方法以Web of Science(WOS)数据库为英文文献来源,以中国知网(CNKI)、万方数据知识服务平台为中文文献来源,检索2012年1月1日—2022年3月31日发表的CCBT相关文献,利用CiteSpace6.1R3软件进行文献计量图谱分析。结果最终纳入中文文献73篇,英文文献1449篇,中英文献年发文量均呈逐年上升趋势;国外发达国家的科研产出较多且彼此合作较紧密,中国学者在此领域起步较晚其影响较小;关键词共现分析结果表明国内外CCBT的研究热点均集中在焦虑、抑郁、失眠等症状的临床改善,研究热点从精神疾病患者向躯体障碍患者过渡,使用手段拓展至移动终端设备并关注“数字健康”概念。结论CCBT对临床患者的焦虑、抑郁等症状的改善效果确切,是护理人员实现临床精神心理护理工作的有效助手,未来发展将与健康保健交叉融合,我国研究者应积极利用我国5G技术优势及智能手机普及率开发适合我国人民的CCBT工具,提升个体心理健康水平。

CCBT-I对妊娠中期失眠孕妇睡眠质量及T淋巴细胞亚群水平的影响

目的分析计算机化认知行为治疗(CCBT-I)对妊娠中期失眠孕妇睡眠质量及T淋巴细胞亚群的影响。方法选择2020年10月至2022年8月该院产科门诊接诊的妊娠中期失眠孕妇60例作为研究对象,采用随机数字表法分为对照组(常规干预)和研究组(给予CCBT-I),每组30例。评估对比两组孕妇干预前及干预后睡眠质量、失眠严重程度、嗜睡程度、抑郁及焦虑情况等,并进行血清T淋巴细胞亚群检测。结果研究组孕妇干预后失眠严重程度指数、匹兹堡睡眠质量指数、雅典失眠量表、爱泼沃斯嗜睡量表、状态-特质焦虑问卷、贝克抑郁量表评分均低于对照组,CD3^(+)、CD4^(+)T淋巴细胞水平均高于对照组,差异均有统计学意义(P<0.05)。结论给予妊娠中期失眠孕妇CCBT-I可明显改善其睡眠质量,缓解其抑郁和焦虑情绪,提高孕妇免疫力。

电脑中频治疗仪联合电子针疗仪在腰椎间盘突出致坐骨神经痛中的应用效果研究

目的 探讨电脑中频治疗仪联合电子针疗仪在腰椎间盘突出致坐骨神经痛中的应用效果及对血清炎症因子的影响。方法 90例腰椎间盘突出致坐骨神经痛患者,按随机数字表法分为对照组和观察组,每组45例。对照组单纯给予电子针疗仪治疗,观察组给予电脑中频治疗仪联合电子针疗仪治疗。比较两组患者治疗前及治疗8周结束时视觉模拟评分法(VAS)、现时疼痛强度(PPI)、Oswestry功能障碍指数量表(ODI)、改良罗兰-莫里斯残疾问卷(RMDQ)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分及炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平,临床疗效,不良反应发生情况。结果 治疗8周结束时,两组患者VAS、PPI、ODI、RMDQ评分低于本组治疗前,WHOQOL-BREF评分高于本组治疗前,且观察组患者VAS、PPI、ODI、RMDQ评分分别为(2.20±0.90)、(2.02±0.80)、(10.98±2.52)、(2.28±0.45)分,低于对照组的(4.25±1.18)、(2.65±0.96)、(17.45±2.32)、(5.84±0.66)分,WHOQOL-BREF评分(72.25±2.33)分高于对照组的(66.26±2.65)分,差异具有统计学意义(P<0.05)。治疗8周结束时,两组患者hs-CRP、IL-6、TNF-α水平均低于本组治疗前,且观察组患者hs-CRP、IL-6、TNF-α水平分别为(9.02±2.25)mg/L、(51.08±6.25)pg/ml、(22.75±3.46)pg/ml,低于对照组的(10.45±2.40)mg/L、(94.75±8.46)pg/ml、(55.18±6.60)pg/ml,差异具有统计学意义(P<0.05)。观察组患者临床总有效率为95.56%(43/45),明显高于对照组的80.00%(36/45),差异具有统计学意义(P<0.05)。两组患者治疗过程中未见明显不良反应。结论 电脑中频治疗仪联合电子针疗仪干预能有效改善腰椎间盘突出致坐骨神经痛患者的疼痛症状,促进腰椎功能恢复,改善躯体活动受限及生活质量,减轻局部炎症反应,值得临床推广应用。

电脑中频治疗仪联合康复训练对脑卒中伴上肢痉挛患者腕手功能障碍的影响

目的 探讨电脑中频治疗仪联合康复训练对脑卒中伴上肢痉挛患者腕手功能障碍的影响。方法 60例脑卒中伴上肢痉挛患者作为研究对象,按收治顺序分为对照组和观察组,每组30例。对照组患者单纯进行常规康复训练,观察组患者给予电脑中频治疗仪联合康复训练治疗。比较两组患者干预前后的各量表[Fugl-Meyer运动功能评分量表(FMA)、改良Ashworth量表(MAS)、日常生活能力量表(ADL)、视觉模拟评分法(VAS)]评分、10 s抓握测试(HGRT)、患侧腕关节活动度,临床疗效,不良反应发生情况。结果 干预8周结束时,两组患者的FMA、ADL评分高于本组干预前, MAS、VAS评分低于本组干预前, HGRT多于本组干预前,且观察组患者的FMA评分(30.08±4.13)分、ADL评分(72.35±12.35)分高于对照组的(22.85±4.39)、(54.45±12.66)分, MAS评分(1.35±0.20)分、VAS评分(1.05±0.95)分低于对照组的(2.20±0.10)、(3.10±1.50)分, HGRT(13.35±3.28)次多于对照组的(9.35±3.03)次,差异具有统计学意义(P<0.05)。干预8周结束时,两组患者患侧腕关节掌屈、背伸、桡偏、尺偏活动度均大于本组干预前,且观察组患者患侧腕关节掌屈、背伸、桡偏、尺偏活动度分别为(58.21±11.20)、(21.76±6.63)、(11.24±2.88)、(25.09±6.01)°,均大于对照组的(51.56±10.10)、(13.83±5.74)、(7.65±3.22)、(18.20±5.08)°,差异具有统计学意义(P<0.05)。观察组的临床总有效率为86.67%,高于对照组的63.33%,差异具有统计学意义(P<0.05)。两组患者治疗过程中均未见明显不良反应。结论 电脑中频治疗仪联合康复训练能有效降低脑卒中伴上肢痉挛患者的肌张力,减轻疼痛症状,促进上肢运动功能恢复,提高腕关节活动度及抓握功能,提高日常生活能力。

Effects of different intervention methods on psychological flexibility,negative emotions and sleep quality in chronic hepatitis B

BACKGROUND Patients with chronic hepatitis B(CHB)experience various problems,including low psychological flexibility,negative emotions,and poor sleep quality.Therefore,effective nursing interventions are required to reduce adverse events.Acceptance and commitment therapy(ACT)combined with enabling cognitivebehavioral education(ECBE)can improve patients'psychological and sleep.Therefore,we speculate that this may also be effective in patients with CHB.AIM To investigate the effects of different intervention methods on psychological flexibility,negative emotions,and sleep quality in patients with CHB.METHODS This retrospective study examined clinical and evaluation data of 129 patients with CHB.Intervention methods were divided into a conventional group(routine nursing,n=69)and a combination group(ACT combined with ECBE,n=60).We observed changes in psychological flexibility,negative emotions,sleep quality,and self-care ability in both groups.Observation items were evaluated using the Acceptance and Action Questionnaire-2nd Edition(AAQ-II),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Pittsburgh Sleep Quality Index(PSQI),and Exercise of Self-Care Agency Scale(ESCA).RESULTS Compared with the conventional group,the AAQ-II score of the combined group was lower(F_(between-group effect)=8.548;F_(time effects)=25.020;F_(interaction effects)=52.930;all P<0.001),the SAS score(t=5.445)and SDS score(t=7.076)were lower(all P<0.001),as were the PSQI dimensions(tsleep quality=4.581,tfall sleep time=2.826,tsleep time=2.436,tsleep efficiency=5.787,tsleep disorder=5.008,thypnotic drugs=3.786,tdaytime dysfunction=4.812);all P<0.05).The ESCA scores for all dimensions were higher(thealth knowledge level=6.994,t self-concept=5.902,tself-responsibility=19.820,tself-care skills=8.470;all P<0.001).CONCLUSION ACT combined with ECBE in patients with CHB can improve psychological flexibility and sleep quality,alleviate negative emotions,and improve self-care.

计算机化认知行为联合阿戈美拉汀治疗精神分裂症后抑郁的临床效果

目的研究计算机化认知行为(computerized cognitive behavioral therapy,CCBT)联合阿戈美拉汀治疗精神分裂症的临床效果。方法抽取福建省福州神经精神病防治院精神科2020年5月—2022年5月收治的68例精神分裂症后抑郁患者,根据治疗方式不同分为对照组(n=34)与观察组(n=34),对照组患者实行阿戈美拉汀治疗,观察组患者则在此基础上进行CCBT,比较两组患者的临床疗效、抑郁、焦虑评分、日常生活自理能力评分、认知领域评分、生活质量评分、不良反应发生率。结果观察组患者治疗总有效率为97.06%,高于对照组的76.47%(P<0.05)。治疗后,观察组患者抑郁、焦虑评分为(16.74±2.11)、(11.58±5.54)分,低于对照组的(23.73±2.58)、(22.73±5.56)分(P<0.05)。治疗后,观察组患者日常生活自理能力评分为(88.25±4.11)分,高于对照组的(74.21±4.73)分(P<0.05)。观察组患者精神运动速度、社会认知水平、解决问题能力、记忆力、视觉学习测评得分均高于对照组,差异有统计学意义(P<0.05)。观察组患者生理状态、心理状态、精神评分及社会交往评分均高于对照组,差异有统计学意义(P<0.05)。观察组患者不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论治疗精神分裂症后抑郁患者,采用CCBT与阿戈美拉汀联合的方式可以切实提升患者的生活质量水平、自理能力,消除患者的负面情绪,达到良好的治疗效果,药物使用安全性与有效性较高,建议临床推广应用。

A comparison study of cognitive-behavioral therapy alone versus combination with tapered hypnotic agents in patients with chronic insomnia

Objective To investigate the efficacy of cognitivebehavioraltherapy for insomnia (CBT-i) or combinationwith tapered hypnotic agents. Methods Seventy-five patientswere randomized into either CBT-i group (n = 37)or combination group ( n = 38). The duration of treatmentlasted for 8 weeks. The efficacy was evaluated byPittsburgh sleep quality index (PSQI),Beck depressionindex (BDI),Beck anxiety inventory (BAI) and sleepdiary variables at baseline,in the process and end oftreatment. Results ( 1 ) Compared with the results atbaseline,the total scores of PSQI,BDI and BAI in bothgroups significantly decreased at the end of treatment:CBT-i group,PSQI (4. 7 ± 2. 5) vs. (12. 9 ± 3. 5);BDI (3. 2 ± 4. 4) vs. (9. 7 ± 6. 4);BAI (4. 2 ± 5. 6)vs. ( 10. 7 ± 8. 1 );and combination group, PSQI(5. 8 ± 2. 8) vs. (13. 9 ± 3. 1);BDI (4. 5 ± 4. 8) vs.(13. 8 ± 8. 7);BAI (4. 4 ± 4. 0) vs. (14. 1 ± 6. 3) (allP < 0. 01). (2) Compared with the results at baseline,subjective sleep quality ( SQ ), sleep onset latency(SOL),sleep efficiency (SE),sleep disturbance (SD)and used sleep medication (USM) in PSQI in combinationgroup significantly decreased at week 4 and 8 ( allP < 0. 05). The total sleep time (TST) and daytime dysfunction(DF) in PSQI significantly decreased at week 8( both P < 0. 05 ). ( 3 ) Compared with combinationgroup,improvement of SOL and SE in CBT-i group wassuperior (both P = 0. 01). Conclusion CBT-i for chronicinsomnia is effective in both CBT-i alone and combinationwith tapered hypnotic agents. CBT-i group is superiorin improving SOL and SE. Combination regimen in ourstudy can significantly reduce the doses of medication.

侵袭性肺曲霉病20例

目的分析侵袭性肺曲霉病(IPA)的临床、影像学、病理和微生物学特征,提高对IPA的认识。方法回顾性分析2005年1月至2008年8月我院经肺组织病理检查和(或)肺组织培养确诊的20例IPA病人的临床资料。结果有基础疾病者(A组)13例,包括恶性肿瘤9例(其中血液系统恶性肿瘤5例)、慢性阻塞性肺疾病2例、肺结核1例、支气管扩张症1例;无基础疾病者(B组)7例,其中2例有长期绒毛玩具接触史,1例有霉变稻谷接触史,3例有污水吸入史。20例病人肺部均有病变,同一病人可以出现多种改变。16例为多发性肺部病变,其中7例为两肺多发性浸润性阴影和(或)实变影,9例为多发性结节影;4例为单发性病变,包括孤立结节影2例,节段性肺实变2例。8例(40.0%)形成空洞,空洞内均未见液平面。18例给予抗真菌药物治疗,总有效率为55.6%(10/18),A组和B组有效率分别为45.5%和5/7。治疗有效者平均症状缓解时间为(12.0±2.8)d,胸部CT检查肺部病灶好转时间为(1 7.4±2.9)d,胸部CT检查显效时间(34.3±9.9)d,活动性病灶基本吸收时间为(56.4±6.2)d。结论IPA可发生于无基础疾病的免疫功能正常病人。IPA的胸部CT检查表现以两肺多发性病变(多发结节)为主,易形成无"液平面"的空洞。肺部活动性病灶基本吸收时间约需6周或更长。

计算机认知矫正治疗对提高精神分裂症患者社会功能水平的研究

目的探讨计算机认知矫正治疗(CCRT)对提高精神分裂症患者社会功能水平的作用。方法收集2015年1~12月杭州市第七人民医院收治的处于康复期的精神分裂症患者100例,按照随机数字表法分为观察组和对照组,每组各50例。观察组患者接受计算机认知矫正治疗,对照组患者参与常规工娱活动,均持续3个月。治疗3个月后,采用阳性与阴性症状量表(PANSS)评估两组患者的病情严重程度;采用威斯康星卡片分类测验(WCST)评估两组患者的认知功能;采用社会功能缺陷筛选量表(SDSS)、个人和社会功能量表(PSP)评价两组患者的社会功能状况。结果两组患者的治疗前病情严重程度、认知功能、社会功能评分值差异无统计学意义(P>0.05);治疗3个月后,观察组PANSS总分、阳性量表分、阴性量表分、复合量表分均低于对照组(P<0.05);观察组WCST完成卡片总数、正确分类卡片数、完成分类数均高于对照组,持续错误数、随机错误数均低于对照组(P<0.05);观察组SDSS评分低于对照组(P<0.05);观察组PSP评分中社会中有用的活动、个人和社会的关系、自我照料、干扰和攻击行为等分值高于对照组(P<0.05)。结论 CCRT治疗可稳固康复期精神分裂症患者病情,在增强认知功能、社会功能方面具有卓越效果。