广泛性焦虑障碍两种方法撤减苯二氮卓药物的对照研究  

Efficacy of Cognitive-behavioral Self-help Therapy for Generalized Anxiety Disorder(GAD) to Withdraw from Long-term Benzodiazepine(BZD) Use

作　　者：王继辉[1] 吴小立[1] 甘照宇[1] 张海燕[1] 

机构地区：[1]中山大学附属第三医院心理科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2013年第1期118-123,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2009B080701080)

摘　　要：【目的】研究认知行为自助疗法(CBT-SH)联合递减疗法在广泛性焦虑障碍(GAD)患者中停止使用苯二氮卓类(BZD)药物中的作用。【方法】对象为门诊GAD患者,连续使用BZD类药物超过3个月,共60例,随机分为研究组和对照组各30例,对照组采用药物剂量递减疗法逐渐停用BZD药物,研究组联合递减疗法和CBT-SH,比较两组疗效的差异。在基线及治疗后2、4、6、10周末评定汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、匹茨堡睡眠质量指数量表(PSQI)得分。【结果】10周末,研究组和对照组成功停用率分别为57%(17/30)和27%(8/30),差异具有统计学意义(P=0.018);研究组和对照组BZD剂量分别为1.19(S=1.69)mg.d-1和3.64(S=3.47)mg.d-1,差异具有统计学意义(P=0.004)。回归分析结果显示,患者年龄小、入组前BZD使用时间短、联合使用CBT-SH是BZD成功停药的有利影响因素(P<0.05)。【结论】递减疗法联合CBT-SH更有助于GAD患者摆脱长期使用BZD药物;患者年龄越大、使用BZD药物时间越长,越不容易成功停用。[ Objective ] To evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use for generalized anxiety disorder （GAD）, and to evaluate the value of additional cognitive behavioral therapy （CBT-SH）. [Methods] A 10-week controlled trial was conducted in which 60 stabilized GAD patients attempting to discontinue long-term benzodiazepines （BZD） use （more than 3 months） were assigned to tapering off plus CBT-SH （intervention group, n = 30）, or tapering off alone （control group, n = 30）. All patients were assessed with Hamilton Anxiety Scale （HAMA）, Hamilton Depression Scale （HAMD, 24-items） and Pittsburgh Sleep Quality Index （PSQI） on baseline and at the end of the 1st, 2nd, 6th, and 10th week treatment. [ Results ] At the end of 10th week, 17（57%） patients in the intervention group and 8 （27%） in the control group had discontinued benzodiazepine use （P = 0.018）; the daily dose of BZD in intervention group was lower than that in control group [ （1.19 ± 1.69） mg.d- vs （3.64 ± 3.47） mg＇d-j, P = 0.004 ]. According to the logistic regression model, patients＇ age, the duration of BZD use and CBT-SH addition were significantly associated with the probability of BZD discontinuation （P 〈 0.05）. [Conclusion] In patients with stabilized GAD, the addition of CBT-SH to tapering off produces added benefits for withdrawing from BZD long-term use during acute therapy, old age and long-term BZD use are the negative predictors of BZD discontinuation.

关 键 词：广泛性焦虑障碍 苯二氮卓 递减疗法 认知行为疗法 

分 类 号：R74[医药卫生—神经病学与精神病学]