团体心理治疗在脑卒中后抑郁治疗中的应用  

Group Psychotherapy in Treatment of Post Stroke Depression

作　　者：曹巍巍[1] 于建敏[1] 孙淑艳[1] 孙彦波[1] 栾琳[1] 蔡秀娟[1] 胡芳[1] 

机构地区：[1]中国人民解放军第107中心医院神经内科,烟台264002

出　　处：《中国心理卫生杂志》2009年第2期100-104,共5页Chinese Mental Health Journal

摘　　要：目的:探讨团体心理治疗对脑卒中后抑郁(post stroke depression,PSD)治疗的可行性及临床疗效。方法:将288名PSD患者随机分为常规治疗组(A组)、常规治疗加口服氟西汀组(B组)、常规治疗加团体心理治疗组(C组)、常规治疗合并团体心理治疗和口服氟西汀组(D组)进行前瞻性研究,分别在治疗前后用汉密尔顿抑郁量表-24项(HAMD-24)和Barthel指数(BI)评定各组抑郁情绪和日常生活能力的变化。结果:治疗后B、D两组HAMD总分均低于治疗前[(30.2±4.2)vs.(35.4±5.8),(26.7±5.0)vs.(35.1±6.2);均P<0.001],而BI总分均高于治疗前[(62.4±13.0)vs.(46.7±9.1),(80.1±10.3)vs.(45.4±14.7);均P<0.001]。治疗后A组HAMD总分高于治疗前[(38.8±5.7)vs.(35.1±5.2);P<0.001],BI总分低于治疗前[(36.3±7.5)vs.(45.2±7.0);P<0.001]。C组HAMD总分、BI总分与治疗前相比差异无统计学意义[(36.2±5.0)vs.(36.8±4.4),(42.7±8.3)vs.(44.4±9.6),均P>0.05]。结论:团体心理治疗结合抗抑郁药物治疗能明显改善PSD患者的抑郁情绪,提高其日常生活能力,亦能纠正认知障碍,缓解躯体症状,提高患者生活质量,有可行性,值得临床推广。Objective： To explore the feasibility and clinical effect of group psychotherapy for post stroke depression （ PSD ） . Methods： The 288 PSD patients were randomly divided into 4 groups which were group A （ with conventional therapy）, group B （with conventional therapy and fluoxetine） , group C （with conventional therapy adding group psychotherapy ）, and group D （ with above three methods of treatment） for prospective study. The subjects were assessed for the changes of depression emotion and the ability of daily living with HAMD and Barthel Index （BI） . Results： The patients in group B and D took lower HAMD scores [ （30.2 ±4.2） vs. （35.4 ±5.8）, （26.7±5.0） vs. （35.1 ±6.2）; P〈0. 001] , while higher BI scores [ （62.4±13.0） vs. （46.7 ±9.1）, （ 80. 1 ± 10. 3 ） vs. （ 45.4 ± 14.7 ） ; P 〈 0. 001 ] compared with pre-treatment. However, in group A, there were opposite consequences to the above [HAMD： （38.8±5.7） vs. （35.1 ±5.2）, BI： （36.3±7.5） vs. （45.2± 7. 0） ; P 〈 0. 001 ] . There were no significant differences compared with pre-treatment in group C [ （36. 2 ± 5.0） vs. （36. 8 ± 4.4）, （ 42.7 ± 8. 3 ） vs. （ 44. 4 ± 9.6）, P 〉 0. 05 ] . Conclusion： Group psychotherapy adding antidepression medicine not only can improve depressive emotion and common living ability of the patients with PSD, but also can correct their cognitive disturbance and relieve their body symotoms. Thereby, their living quality can be promoted. The therapy is useful and worth to be spread.

关 键 词：心理治疗 脑卒中 抑郁障碍 前瞻性研究 

分 类 号：R749.055[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]