认知行为治疗联合药物治疗与单纯药物治疗强迫障碍患者的随机对照研究  

The randomized controlled study of the effect of medication with cognitive behavioral therapy and medication on obsessive-compulsive disorder

作　　者：孟繁强[1] 李占江[1] 罗佳[1] 韩海英[1] 杨威[1] 任帅[1] 郭萌[1] 黄芳芳[1] 姚淑敏[1] 杨晓婕[1] 黄悦勤[2] 

机构地区：[1]首都医科大学附属北京安定医院/临床心理学系精神疾病诊断与治疗北京市重点实验室,100088 [2]北京大学第六医院北京大学精神卫生研究所卫生部精神卫生学重点实验室

出　　处：《中华精神科杂志》2015年第6期324-330,共7页Chinese Journal of Psychiatry

基　　金：国家科技支撑计划课题（2007BA117801,2009BA177811）

摘　　要：目的比较单用SSRIs与SSRIs合并认知行为治疗（cognitivebehavioraltherapy，CBT）强迫障碍患者的临床疗效。方法选取符合DSM—IV中强迫障碍诊断标准的门诊患者共80例，采用随机数字表法分为单用SSRIs治疗组f简称药物治疗组，n=40）和SSRIs合并CBT组（简称联合治疗组，n=401，分别于0、4、8、12、24、36、48周末采用Y—BOCS、HAMA等对患者进行盲法评定比较药物治疗和联合治疗的临床治疗效果，采用Logistic回归分析治疗效果的影响因素。结果4周末联合治疗组[（20．0±6．4）分与（23．6±6．0）分]及药物治疗组[（20．8±7．0）分与（23．7±6．3）分]Y．BOCS总分均低于基线（t=4．05，P=0．000；t=3．46，P=0．001）。2组患者Y—BOCS总分（F=3．986～7．104，P=0．009-0．049）和Y—BOCS强迫行为因子分（辟5．370～5．895，P=O．017～0．023）自8周末开始至48周末组问差异有统计学意义；2组患者Y—BOCS强迫思维因子分在48周末差异有统计学意义（F=5．523，P=0．021）。Logistic回归分析显示，联合CBT、Y-BOCS总分4周末治疗是否有效对患者48周末的疗效有正性预测作用（OR=8．61、9．25，均P〈0．05）。结论药物联合CBT能有效缓解强迫障碍患者症状，且优于单纯药物治疗，尤其对强迫行为的改善更为突出，且接受CBT、4周末起效的患者在后续的治疗中能获得更好地改善。Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor （SSRIs） treatment and the group of SSRIs combining cognitive behavioral therapy （CBT）. Methods Eighty patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition criteria for obsessive-compulsive disorder were randomly designed to group of SSRIs （n=40）, and combined therapy group （n=40）. The Y-BOCS, HAMA, Global Assessment Function（GAF） were used to assess the efficacy blindly after 0, 4, 8, 12, 24, 36, 48 week treatment, influence factors of effect were evaluated using logistic regression analysis. Results At the end of 4＇h week, the Y-BOCS total score were lower than baseline in both groups （group of SSRIs： 20.8±7.0 vs. 23.7±6.3, t=3.46, P=0.001; group of combined therapy： 20.0±6.4 vs. 23.6±6.0, t=4.05, P=0.000）. The comparision between groups showed that the Y-BOCS total scores and compulsion scores of two group had significant effects from 8th week to 48＇h week （Y-BOCS total scores： F=3.986- 7.104, P=0.009- 0.049; Y- BOCS compulsion scores： F=5.370- 5.895, P=0.017- 0.023）, and the Y-BOCS obsession scores of two groups had a significant effect at the 48th week （F=5.523, P=0.021）. Logistic regression analysis demonstrated that with CBT and the fourth week working had positid forecast on the prognosis of patients with long-term effect（OR=8.61, 9.25, both P〈0.05）. Conclusions SSRIs combining CBT could effectively alleviate symptoms of obsessive-compulsive disorder, and better than single SSRIs group, especially for compulsive behavior. The patients with CBT response at the fourth week can get better improvement in the subsequent treatment.

关 键 词：强迫性障碍 认知疗法 药物疗法 随机对照试验 

分 类 号：R749.7[医药卫生—神经病学与精神病学]