【作者】 史继红；

【导师】 张敬悬；

【作者基本信息】 山东大学 ， 精神病与精神卫生学， 2016， 硕士

【摘要】 目的评估认知行为治疗(CBT)、抗抑郁药物治疗(ADM)和星状神经节阻滞(SGB)等综合治疗躯体形式障碍(SFD)的有效性。方法分组：1 80例躯体形式障碍(SFD)患者随机分为3组,每组60例：P组(心理治疗组),仅接受认知行为治疗(CBT)治疗,失访率为31.7%；B组(生物治疗组),接受抗抑郁药物治疗(ADM)和星状神经节阻滞(SGB)联合治疗,失访率18.4%；C组(心身治疗组),接受认知行为治疗(CBT)、抗抑郁药物治疗(ADM)和星状神经节阻滞(SGB)等综合治疗,失访率23.3%。治疗方法；CBT治疗每周1次,1次60min,共12次,以纠正认知扭曲,改善伴随的情绪症状。ADM一般采用氟西汀20mg/d,共12周；合并失眠症状的患者采用帕罗西汀20mg/d。SGB阻滞采用气管旁入路法,1次／周,共12次,以重建自主神经张力平衡。测量:在治疗期间,每周采用视觉模拟量表(visual analogue scale,VAS)评估疼痛和躯体不适症状的改善程度。于治疗前、治疗后、3月随访和6月随访进行症状自评量表(SCL-90)、特质焦虑问卷(TAI)、Beck抑郁自评问卷(BDI-13)、健康状况调查问卷简表(SF-36)和多伦多述情量表(TAS-20)测量。结果疼痛和躯体不适症状：三组患者治疗期间疼痛和躯体不适VAS评分均呈进行性改善。与P组比较,自治疗后2周,B组和C组患者的疼痛和躯体不适VAS评分改善更为显著(P<0.05)。与B组比较,自治疗后9周,C组患者的疼痛和躯体不适VAS评分改善更为显著(P<0.05)。病情严重程度：与治疗前比较,三组治疗后、3月随访、6月随访的SCL-90躯体化及抑郁和焦虑评分、TAI评分、BDI-13评分均显著降低(P<0.05)。与P组比较,B组和C组治疗后、3月随访、6月随访的SCL-90躯体化及抑郁评分和TAI评分均显著降低,且治疗后、3月随访的BDI-13评分亦均显著降低；C组治疗后、3月随访的SCL-90焦虑评分和6月随访的BDI-13评分均显著较低(P<0.05)。与B组比较,C组治疗后、3月随访、6月随访的SCL-90躯体化及抑郁评分和治疗后、6月随访的TAI评分及治疗后的BDI-13评分均显著减小(P<0.05)。生活质量：与治疗前比较,B组和C组治疗后、3月随访、6月随访的SF-36 PCS和MCS评分显著增加,P组6月随访的SF-36 PCS评分显著增大(P<0.05)。与P组比较,C组治疗后、3月随访、6月随访的SF-36 PCS和MCS评分均显著增加(P<0.05)。与B组比较,C组6月随访的SF-36 PCS评分显著较大(P<0.05)。述情障碍：与治疗前比较,C组治疗后、3月随访、6月随访的TAS总分及因子DIF和DDF评分均显著减小(P<0.05),P组3月随访、6月随访的TAS总分及因子DIF评分均显著降低(P<0.05)。与P组比较,C组6月随访的TAS总分及因子DIF评分均显著较低(P<0.05)。结论 CBT治疗和ADM联合SGB治疗对SFD均有良好的效果,且在3月～6月随访期可维持相对稳定的治疗效果。ADM联合SGB治疗起效更为迅速,CBT治疗更有助于改善SFD患者的述情障碍。然而,CBT、ADM及SGB综合治疗在减轻SFD患者的疾病严重性、增进其生活质量和改善其述情障碍方面更有效。更多还原

【Abstract】 Objective To evaluate the effectiveness of comprehensive intervention with cognitive behavioral therapy (CBT), antidepressant medication (ADM) and stellate ganglion block (SGB) in patients with somatoform disorders (SFD).MethodsAllocation of study groups:180 patients with SFD randomly allocated into three groups, n=60 each group:Group P (psychological treatment) received only CBT with a missing rate of 31.7%, Group B (biological treatment) received ADM and SGB with a missing rate of 18.4%, and Group C (psychosomatic combined treatment) received comprehensive intervention of CBT, ADM and SGB with a missing rate of 23.3%.Interventions:All patients received treatment for twelve consecutive weeks. CBT was provided once a week, each of 60 min duration, to correct cognitive distortions and improve the accompanying emotional symptoms. Fluoxetine 20 mg/d was commonly used in ADM, in particular, Paroxetine 20mg/d in patients with insomnia symptom. SGB was performed one time a week using paratracheal approach to reconstruct the balance of autonomic nervous tension.Measurements:The improvement of pain and somatic discomfort during treatment was assessed using the Visual Analogue Scale (VAS) once a week. All patients were evaluated using Symptom Checklist (SCL-90), Trait Anxiety Inventory (TAI), Beck Depression Inventory (BDI-13), short form health survey (SF-36) and Toronto Alexithymia Scale (TAS-20) before treatment, after treatment, at 3-month follow up and at 6-month follow up.ResultsPain and somatic discomfort:Pain and somatic discomfort was progressively improved during treatment in all three groups. The VAS scores of improvement of pain and somatic discomfort were higher in Group B and Group C than those in Group P since the end of the second week following treatment (P<0.05). The VAS scores of improvement of pain and somatic discomfort were higher in Group C than those in Group B since the end of the ninth week following treatment (P<0.05).Illness severity:In comparison with pretherapy, there was a significant decrease of SCL-90 factor scores of somatization, depression and anxiety, TAI score and BDI-13 score after treatment, at 3-month follow up and at 6-month follow up in all three groups (P<0.05); In comparison with Group P, SCL-90 factor scores of somatization scores and depression, and TAI score after treatment, at 3-month follow up and at 6-month follow up, and BDI-13 score after treatment and at 3-month follow up were lower in Group B and Group C (P<0.05); SCL-90 factor score of anxiety after treatment and at 3-month follow up, and BDI-13 score at 6-month follow up were lower in Group C (P<0.05). In comparison with Group B, SCL-90 factor scores of somatization and depression after treatment, at 3-month follow up and at 6-month follow up, TAI score after treatment and at 6-month follow up and BDI-13 score after treatment were lower (P<0.05).Health-related quality of life:In comparison with pretherapy, there was a significant increase of SF-36 factor scores of physical component summary (PCS) and mental component summary (MCS) after treatment, at 3-month follow up and at 6-month follow up in Group B and Group C (P<0.05), and SF-36 PCS score at 6-month follow up in Group P (P<0.05). In comparison with Group P, SF-36 scores of PCS and MCS after treatment, at 3-month follow up and at 6-month follow up were higher in Group C (P<0.05). In comparison with Group B, SF-36 PCS score at 6-month follow up was higher in Group C (P<0.05).Alexithymia:In comparison with pretherapy, there was a significant decrease of TAS-20 total score and factor scores of difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) at 3-month follow up and at 6-month follow up in Group C (P<0.05), and TAS-20 total score and DIF score at 3-month follow up and at 6-month follow up in Group P (P<0.05). In comparison with Group P, TAS-20 total score and DIF score were lower in Group C (P<0.05).Conclusion Both CBT and ADM with SGB are effective in the treatment of SFD, and the therapeutic effects remain relatively stable at 3-month to 6-month follow up. ADM with SGB has a more rapid onset, while CBT is more helpful to improve alexithymia. The comprehensive intervention of CBT, ADM and SGB is more effective to alleviate illness severity and improve life quality and alexithymia in patients with SFD.更多还原