【摘要】 目的了解认知行为治疗对轻性抑郁障碍的疗效及预后。方法对符合美国精神障碍诊断与统计手册第4版轻性抑郁障碍诊断标准的门诊及住院患者,随机分为帕罗西汀药物治疗组和帕罗西汀合并认知行为治疗组各42例,单纯认知行为治疗组41例。在治疗前、治疗第4周、第8周、随访6个月后,采用Beck抑郁量表(BDI)、汉密顿抑郁量表(HAMD)、自动想法问卷(ATQ)、功能失调性态度问卷(DAS)进行评定。结果治疗前,3组BDI评分分别为:10.1±2.4、9.8±2.4、9.2±2.2,差异无统计学意义(F=1.514,P>0.05);治疗第4周,3组BDI评分均下降,分别为:6.4±2.3、5.4±1.9、7.6±2.0,各组间差异有统计学意义(F=10.908,P<0.01);治疗第8周3组BDI评分继续下降,但差异无统计学意义(F=1.360,P>0.05)。3组显效率分别为64.3%、69.0%和58.5%,差异也无统计学意义(χ2=0.999,P>0.05);随访6个月后认知行为治疗组、药物合并认知行为治疗组疗效(分别为61.0%、71.4%)稳定且差异无统计学意义(χ2=1.063,P>0.05),药物治疗组疗效(38.1%)下降且与认知行为治疗组、药物合并认知行为治疗组疗效差异有统计学意义(χ2=13.135,P<0.01)。治疗前3组ATQ总分、DAS总分差异无统计学意义;治疗第8周,认知行为治疗组、药物合并认知行为治疗组的DAS总分、ATQ总分显著低于药物治疗组,差异有统计学意义。结论认知行为治疗与药物合并认知行为治疗对轻性抑郁障碍的疗效相当,且认知行为治疗能够有效改善功能失调性认知,有预防抑郁复发的作用。更多还原

【Abstract】 Objective: To investigate the efficacy and prognosis of cognitive-behavioral therapy(CBT) in mild depressive disorders.Methods: Outpatients and inpatients with mild depressive disorders according to DSM-IV were randomly divided into paroxetine group(n=42),paroxetine combined with cognitive-behavioral therapy group(n=42) and cognitive-behavioral therapy group(n=41).The efficacy was assessed with the Beck Depression Inventory(BDI),Hamilton Depression Scale(HAMD),Automatic Thoughts Questionnaire(ATQ) and Dysfunctional Attitudes Scale(DAS) before treatment and 4 weeks,8 weeks,and 6 months after treatment.Results:There were no significant difference of the BDI scores among the 3 groups before treatment(F=1.514,P=0.224.The BDI scores decreased 4 weeks after treatment and there was significant diffreence among the three groups(F=10.908,P<0.01).The BDI scores of the three groups decreased at the 8 weeks after treatment without significant difference.The response rate was 64.3%、69.0% and 58.5% respectively without significant group difference.There was no difference of the response rates between CBT group and the combination group(61.0% vs.71.4%,χ2 =1.063,P>0.05).The response rate of the medicine group decreased(38.1%)and there was difference of the response rate between the CBT group and the combination group(χ2=13.135,P<0.01).There was no difference of the total scores of ATQ and DAS among the three groups.The DAS scores and ATQ scores of the CBT group and combination group were siginicantly lower than that of the medicine group at 8 weeks after treatment.Conclusion:The efficacy of CBT and paroxetine combined with CBT are similar in mild depression.CBT can improve dysfunctional cognition and play a role in prevention of depression relapse.更多还原