药物合并认知-应对治疗对强迫性神经症的临床疗效分析  

Clinical effect of pharmacotherapy combined with cognitive-coping therapy on obsessive-compulsive disorder

作　　者：胡宪章[1] 马建东[1] 

机构地区：[1]新乡医学院第二附属医院,河南新乡453002

出　　处：《新乡医学院学报》2011年第1期68-72,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨药物合并认知-应对治疗（CCT）对强迫性神经症（简称强迫症）的疗效。方法选择符合美国精神疾病《统计与诊断手册》诊断标准的强迫症患者45例,随机分为药物治疗组（n=23）和药物合并CCT组（n=22）。药物治疗以氯米帕明为主,平均每日口服（139.5±49.5）mg,可合并5-羟色胺重摄取阻断剂。CCT门诊治疗每周1~2次,每次约40 min,共4周;随后每2周进行1次约30 min的电话治疗,共4周;然后随访10个月,根据病情变化进行每月1~2次的电话治疗。在治疗前后采用耶鲁-布朗强迫症量表（Y-BOCS）对症状进行评定。结果药物合并CCT组在4周及3、6、12个月的6项Y-BOCS严重程度总分减分率、有效率和临床痊愈率均高于药物治疗组（P〈0.001）。药物合并CCT组治疗有效出现时间明显提前。结论药物合并CCT是治疗强迫症的有效方法。Objective To investigate the efficacy of medication combined with cognitive-coping therapy（CTT） on obsessive-compulsive disorder.Methods Forty-five patients who correspond with the United States mental illness ＂Diagnostic and statistical Manual of Menual Disorders＂ diagnostic criteria for obsessive-compulsive disorder were selected and randomly divided into pharmacotherapy group（n=23） and pharmacotherapy plus CCT group（n=22）.With regard to pharmacotherapy：chlorimipramine-based,daily oral administration was（139.5±49.5）mg average,in combination with some selective serotonin reuptake inhibitors（SSRIs） when necessary.Ambulatory treatments of CCT were 1 or 2 times per week for 4 weeks,each time lasting around 40 minutes.Then treatments through telephone about 30 minutes were afforded every 2 weeks for 4 weeks;Followed up for 10 months,the phone therapy of 1 or 2 times a month were given based on changes of patient′s condition.Symptoms were evaluated by Yale-Brown Obsessive Compulsive Scale（Y-BOCS） before and after treatment.Results The reduction percentage of 6-item Y-BOCS severity score,effective rate and clinical recovery rate at four weeks,three months,six months and twelve months in pharmacotherapy plus CCT group were significantly higher than in pharmacotherapy group（P0.001）.The initial therapeutic effects in pharmacotherapy plus CCT group appeared in advance obviously.Conclusion Pharmacotherapy plus CCT is an effective approach to treat patients with obsessive-compulsive disorder.

关 键 词：强迫性神经症 认知-应对治疗 药物治疗 

分 类 号：R749[医药卫生—神经病学与精神病学]